Healthcare Provider Details

I. General information

NPI: 1124778634
Provider Name (Legal Business Name): FARZANA IBNAT YEASMIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S STAPLEY DR STE 101
MESA AZ
85204-6682
US

IV. Provider business mailing address

8888 E RAINTREE DR STE 300
SCOTTSDALE AZ
85260-3968
US

V. Phone/Fax

Practice location:
  • Phone: 800-233-3264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011936
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: