Basic Information
| Provider Information | |||||||||
| NPI: | 1629142336 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | URSEA | ||||||||
| FirstName: | ROXANA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6060 N FOUNTAIN PLAZA DR | ||||||||
| Address2: | STE 250 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857047873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208774240 | ||||||||
| FaxNumber: | 5208774241 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 N ALVERNON WAY STE 301 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857111848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206941460 | ||||||||
| FaxNumber: | 5206941464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 02/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 32898 | AZ | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 932477 | 05 | AZ | MEDICAID |