Healthcare Provider Details

I. General information

NPI: 1043873292
Provider Name (Legal Business Name): RUCHI JAYESHBHAI SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 W BELL RD STE 130
GLENDALE AZ
85308-3896
US

IV. Provider business mailing address

6220 W BELL RD STE 130
GLENDALE AZ
85308-3896
US

V. Phone/Fax

Practice location:
  • Phone: 480-587-6775
  • Fax:
Mailing address:
  • Phone: 480-587-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number179297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: