1699363929 NPI number — RESTORATIVE BREAST CENTER LLC

Table of content: DR. TARAH RUTH DESATOFF OD (NPI 1497317168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699363929 NPI number — RESTORATIVE BREAST CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESTORATIVE BREAST CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699363929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5780 N SWAN RD STE 180
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85718-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-448-9490
Provider Business Mailing Address Fax Number:
520-448-9492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5780 N SWAN RD STE 180
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:
85718-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-448-9490
Provider Business Practice Location Address Fax Number:
520-448-9490
Provider Enumeration Date:
01/03/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAHABIR
Authorized Official First Name:
RAMAN
Authorized Official Middle Name:
CHAOS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-499-4599

Provider Taxonomy Codes

  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0099X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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