Healthcare Provider Details

I. General information

NPI: 1528033917
Provider Name (Legal Business Name): JESSE S SETHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 N 94TH DR STE J1
PEORIA AZ
85381-4246
US

IV. Provider business mailing address

13460 N 94TH DR STE J1
PEORIA AZ
85381-4246
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-8816
  • Fax: 623-298-0168
Mailing address:
  • Phone: 623-876-8816
  • Fax: 623-298-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35076
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: