Healthcare Provider Details

I. General information

NPI: 1588489249
Provider Name (Legal Business Name): NITIN NANDA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19555 N 59TH AVE
GLENDALE AZ
85308-6813
US

IV. Provider business mailing address

19555 N 59TH AVE
GLENDALE AZ
85308-6813
US

V. Phone/Fax

Practice location:
  • Phone: 480-646-9430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPG225420
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: