Healthcare Provider Details

I. General information

NPI: 1649460593
Provider Name (Legal Business Name): REZA SALEHI-RAD D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18699 N 67TH AVE SUITE 280
GLENDALE AZ
85308-7140
US

IV. Provider business mailing address

3333 E CAMELBACK RD STE 180
PHOENIX AZ
85018-2322
US

V. Phone/Fax

Practice location:
  • Phone: 623-240-4277
  • Fax: 623-566-0263
Mailing address:
  • Phone: 602-977-0484
  • Fax: 602-224-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number5401
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: