Individual
DR. ROSA TRINIDAD C TABANDA-LICHAUCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 EL CAMINO REAL, SIERRA VISTA, AZ 85635-2812
(520) 335-1800
(520) 335-2743
Mailing address
PO BOX 609, HEREFORD, AZ 85615-0609
(520) 335-1800
(520) 335-2743
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36678
AZ
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
36678
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
824163
—
AZ
Enumeration date
05/18/2007
Last updated
08/27/2014
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