Basic Information
| Provider Information | |||||||||
| NPI: | 1710994249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARIETTA MURRAY | ||||||||
| FirstName: | TATYANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6050 N CORONA RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204698700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6050 N CORONA RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857041096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204698700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 03/17/2009 | ||||||||
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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 | 2084P0800X | ME88138 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | 41339 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 272236400 | 05 | FL | MEDICAID |