Healthcare Provider Details

I. General information

NPI: 1922731207
Provider Name (Legal Business Name): MEENA RAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S OCOTILLO AVE
BENSON AZ
85602-6403
US

IV. Provider business mailing address

10322 E SNYDER CREEK PL
TUCSON AZ
85749-8396
US

V. Phone/Fax

Practice location:
  • Phone: 313-265-7214
  • Fax:
Mailing address:
  • Phone: 313-265-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number65002
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: