NPIMap

Individual provider Active NPI

Rosa Trinidad C Tabanda-Lichauco, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Sierra Vista, AZ
National Provider Identifier
1922216233
Registry record updated Aug 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
36678 Issued in AZ
Practice address
300 El Camino Real
Sierra Vista, AZ 85635-2812
Phone
(520) 335-1800
Fax
(520) 335-2743
NPI assigned
May 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 36678 AZ
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 36678 AZ Primary

Addresses

Primary practice location

300 El Camino Real
Sierra Vista, AZ 85635-2812

Mailing address

PO Box 609
Hereford, AZ 85615-0609
Phone (520) 335-1800

Other identifiers 1

IdentifierTypeStateIssuer
824163MedicaidAZ

Other names 1

  • Rosa Trinidad C Tabanda Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090625000137 AZ Practitioner - Pathology 1850442278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pathology Specialist of Arizona, LLPGroup PAC ID 4789583188, 69 clinicians

Practice addresses (Care Compare)

424 S 56TH St
Suite 120
Phoenix, AZ 85034-2177
Phone (602) 685-5211

Hospital & facility affiliations

  • Tucson Medical Center Hospital, Tucson, AZ, CCN 030006
  • Banner - University Medical Center Tucson Campus Hospital, Tucson, AZ, CCN 030064
  • Northwest Medical Center Hospital, Tucson, AZ, CCN 030085
  • St Joseph'S Hospital Hospital, Tucson, AZ, CCN 030011
  • Oro Valley Hospital Hospital, Oro Valley, AZ, CCN 030114

Merit-based Incentive Payment System (MIPS)

Final score
78.75 of 100Reported as group
Quality
75
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
001222NYMDMental Health Counselor
36678AZMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Specialist of Arizona, LLP Anatomic Pathology & Clinical Pathology CurrentSince Oct 1, 2023 Accepting new patients
Sonoran Radiology LTD PastSince Oct 1, 2023 Accepting new patients
Beth Israel Medical Center Past Accepting new patients
Pathlab Inc Anatomic Pathology & Clinical Pathology Past Accepting new patients

Locations

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

424 S 56th St
Ste 120
Phoenix, AZ 85034
Phone (480) 478-8059

350 N Wilmot Rd
Tucson, AZ 85711
Phone (520) 873-3000

7350 E Speedway Blvd
Ste 101
Tucson, AZ 85710

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409097600000",
    "number": "1922216233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "HEREFORD",
            "state": "AZ",
            "postal_code": "856150609",
            "telephone_number": "520-335-1800",
            "fax_number": "520-335-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 EL CAMINO REAL",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352812",
            "telephone_number": "520-335-1800",
            "fax_number": "520-335-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABANDA-LICHAUCO",
        "first_name": "ROSA TRINIDAD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2014-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "36678",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AZ",
            "license": "36678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "824163",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROSA TRINIDAD",
            "last_name": "TABANDA",
            "middle_name": "C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sierra Vista, AZ

Sources for this page

Verify at the official NPI Registry.