Provider Demographics
NPI:1356023618
Name:DIDOMENICO, JAMES (RN, LMT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:DIDOMENICO
Suffix:
Gender:M
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 S BECK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-3623
Mailing Address - Country:US
Mailing Address - Phone:520-358-4438
Mailing Address - Fax:
Practice Address - Street 1:3113 S BECK DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-3623
Practice Address - Country:US
Practice Address - Phone:520-358-4438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27228163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)