Provider Demographics
NPI:1780993600
Name:EL RIO SANTA CRUZ NEIGHBORHOOD
Entity type:Organization
Organization Name:EL RIO SANTA CRUZ NEIGHBORHOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:G
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-601-0607
Mailing Address - Street 1:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85702-1231
Mailing Address - Country:US
Mailing Address - Phone:520-670-3813
Mailing Address - Fax:520-670-7560
Practice Address - Street 1:101 W IRVINGTON RD BLDG 10
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-3050
Practice Address - Country:US
Practice Address - Phone:520-309-4585
Practice Address - Fax:520-309-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0053083336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126882OtherPK