Individual
AISSATA KEITA II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5818 E ROSEWOOD ST, TUCSON, AZ 85711-1533
(520) 514-2121
Mailing address
5818 E ROSEWOOD ST, TUCSON, AZ 85711-1533
(520) 514-2121
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-2647
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095265
—
AZ
Enumeration date
11/09/2006
Last updated
07/09/2007
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