Healthcare Provider Details

I. General information

NPI: 1689157166
Provider Name (Legal Business Name): HEALTHY LIVING DIABETES AND ENDOCRINOLOGY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 W CHANDLER BLVD B-4 BUILDING B, SUITE 4
CHANDLER AZ
85225-2548
US

IV. Provider business mailing address

908 W CHANDLER BLVD B-4 BUILDING B, SUITE 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 TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NAGA NALINI TIRUMALASETTY
Title or Position: MEMBER/MANAGING EMPLOYEE
Credential: MD, ECNU, FACE
Phone: 480-269-6448