1285125559 NPI number — DR. JENNIFER ROSEANNA TAFOYA-BOCCA AU.D

Table of content: DR. JENNIFER ROSEANNA TAFOYA-BOCCA AU.D (NPI 1285125559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285125559 NPI number — DR. JENNIFER ROSEANNA TAFOYA-BOCCA AU.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAFOYA-BOCCA
Provider First Name:
JENNIFER
Provider Middle Name:
ROSEANNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOCCA
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ROSEANNA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285125559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7225 N ORACLE RD STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORO VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-6323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-639-8760
Provider Business Mailing Address Fax Number:
520-843-4852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7225 N ORACLE RD STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-6323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-639-8760
Provider Business Practice Location Address Fax Number:
520-843-4852
Provider Enumeration Date:
05/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  DA11302 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DA11302 . This is a "ARIZONA STATE MEDICAL BOARD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".