Healthcare Provider Details

I. General information

NPI: 1649135005
Provider Name (Legal Business Name): AZGUPLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9159 W THUNDERBIRD RD # 105
PEORIA AZ
85381-4910
US

IV. Provider business mailing address

9159 W THUNDERBIRD RD # 105
PEORIA AZ
85381-4910
US

V. Phone/Fax

Practice location:
  • Phone: 623-235-7065
  • Fax: 623-235-7065
Mailing address:
  • Phone: 623-235-7065
  • Fax: 623-235-7065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RUCHIR GUPTA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 623-235-7065