| Desert Rose | |
|
5055 E Broadway Blvd Ste A200 Tucson AZ 85711-3649 | |
| (520) 901-4800 | |
| (520) 901-4700 |
| Full Name | Desert Rose |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 5055 E Broadway Blvd Ste A200, Tucson, Arizona |
| Authorized Official Name and Position | Rose Mary Lopez (PRESIDENT AND CEO) |
| Authorized Official Contact | 5207211887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Rose Po Box 86537 Tucson AZ 85754-6537 Ph: (820) 721-1887 | Desert Rose 5055 E Broadway Blvd Ste A200 Tucson AZ 85711-3649 Ph: (520) 901-4800 |
| NPI Number | 1558898635 |
|---|---|
| Provider Enumeration Date | 05/19/2017 |
| Last Update Date | 05/25/2021 |
| Certification Date | 05/25/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558898635 | NPI | - | NPPES |
| OTC9298 | Other | AZ | BMFL LICENSE |
| 004780 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| 251S00000X | Community/behavioral Health | CSGL8299 (Arizona) | Secondary |
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