Healthcare Provider Details

I. General information

NPI: 1003168840
Provider Name (Legal Business Name): NAGA NALINI TIRUMALASETTY MD,ECNU,FACE.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAGA NALINI SAMMETA M.D.

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 W CHANDLER BLVD STE 4
CHANDLER AZ
85225-2548
US

IV. Provider business mailing address

908 W CHANDLER BLVD STE 4
CHANDLER AZ
85225-2548
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-6448
  • Fax: 779-204-2331
Mailing address:
  • Phone: 480-269-6448
  • Fax: 779-204-2331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2014001412
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number55238
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: