Provider Demographics
NPI:1215055777
Name:PASCUA YAQUI TRIBE
Entity type:Organization
Organization Name:PASCUA YAQUI TRIBE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BASILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-879-5720
Mailing Address - Street 1:7474 S. CAMINO DE OESTE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-9308
Mailing Address - Country:US
Mailing Address - Phone:520-879-5720
Mailing Address - Fax:520-879-5730
Practice Address - Street 1:4631 W CALLE TORIM
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85757
Practice Address - Country:US
Practice Address - Phone:520-879-5720
Practice Address - Fax:520-879-5730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASCUA YAQUI TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ344953Medicaid