MEDICARE: RD INTEGRATED HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	363LA2100X	Acute Care Nurse Practitioner
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1912575093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RD INTEGRATED HEALTH PLLC

Provider Business Mailing Address
First Line	:	5519 W BANFF LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3045
Country	:	US
Telephone Number	:	623-261-5258
Fax Number	:

Provider Business Practice Location Address
First Line	:	5310 W THUNDERBIRD RD STE 202
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4712
Country	:	US
Telephone Number	:	623-301-9992
Fax Number	:	623-432-7006

Authorized Official
Title or Position	:	NP/MANAGER AND MEMBER
Name	:	DR. MALAR KUPPAN
Credential	:	DNP, AGACNP, PMHNP
Telephone Number	:	623-261-5258

Provider Enumeration Date	:	06/15/2021
Last Update Date	:	03/13/2025

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