Healthcare Provider Details

I. General information

NPI: 1912575093
Provider Name (Legal Business Name): RD INTEGRATED HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 W THUNDERBIRD RD STE 202
GLENDALE AZ
85306-4712
US

IV. Provider business mailing address

5519 W BANFF LN
GLENDALE AZ
85306-3045
US

V. Phone/Fax

Practice location:
  • Phone: 623-301-9992
  • Fax: 623-432-7006
Mailing address:
  • Phone: 623-261-5258
  • Fax: 623-432-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALAR KUPPAN
Title or Position: PROVIDER, ADMIN, & OWNER
Credential:
Phone: 623-301-9992