Healthcare Provider Details

I. General information

NPI: 1629079876
Provider Name (Legal Business Name): RAHUL MALHOTRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6316 W UNION HILLS DR 210
GLENDALE AZ
85308
US

IV. Provider business mailing address

6316 W UNION HILLS DR STE 210
GLENDALE AZ
85308-1001
US

V. Phone/Fax

Practice location:
  • Phone: 480-765-2800
  • Fax:
Mailing address:
  • Phone: 480-765-2800
  • Fax: 480-765-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number32305
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number32305
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: