Healthcare Provider Details

I. General information

NPI: 1982446266
Provider Name (Legal Business Name): AYAT NABEEL RASSAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 N ESTRELLA PKWY STE 40
GOODYEAR AZ
85338-9279
US

IV. Provider business mailing address

PO BOX 5204
GOODYEAR AZ
85338-0603
US

V. Phone/Fax

Practice location:
  • Phone: 623-889-3477
  • Fax: 623-889-3478
Mailing address:
  • Phone: 623-889-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308689
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number308689
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: