Healthcare Provider Details

I. General information

NPI: 1568898336
Provider Name (Legal Business Name): POSITIVE MIND PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S LINDSAY RD, STE 124 BLD #6
GILBERT AZ
85297
US

IV. Provider business mailing address

4100 S LINDSAY RD, STE 124 BLD #6
GILBERT AZ
85297
US

V. Phone/Fax

Practice location:
  • Phone: 917-968-8695
  • Fax: 480-361-1922
Mailing address:
  • Phone: 917-968-8695
  • Fax: 480-361-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number44462
License Number StateAZ

VIII. Authorized Official

Name: DR. FARIDA ZAKIR RASSIWALA
Title or Position: MD PSYCHIATRIST
Credential: MD
Phone: 480-361-1922