Healthcare Provider Details

I. General information

NPI: 1861888315
Provider Name (Legal Business Name): YASIR RUDHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 E SUPERSTITION SPRINGS BLVD
MESA AZ
85209
US

IV. Provider business mailing address

6811 E SUPERSTITION SPRINGS BLVD
MESA AZ
85209-4001
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-4000
  • Fax:
Mailing address:
  • Phone: 480-641-4000
  • 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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number56186
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: