Provider Demographics
NPI:1427786722
Name:MOONSTRUCK HOLDINGS PLLC
Entity type:Organization
Organization Name:MOONSTRUCK HOLDINGS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTERROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-270-8639
Mailing Address - Street 1:10043 N ALDER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8592
Mailing Address - Country:US
Mailing Address - Phone:520-270-8639
Mailing Address - Fax:
Practice Address - Street 1:1745 E SKYLINE DR STE 175
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1163
Practice Address - Country:US
Practice Address - Phone:520-203-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-13
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty