Provider Demographics
NPI:1831759240
Name:THE UNIVERSITY OF ARIZONA
Entity type:Organization
Organization Name:THE UNIVERSITY OF ARIZONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTELUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-626-2982
Mailing Address - Street 1:1335 N CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0105
Mailing Address - Country:US
Mailing Address - Phone:520-626-2982
Mailing Address - Fax:520-626-2525
Practice Address - Street 1:1335 N CHERRY AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0105
Practice Address - Country:US
Practice Address - Phone:520-626-2982
Practice Address - Fax:520-626-2525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF ARIZONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty