Healthcare Provider Details

I. General information

NPI: 1316258379
Provider Name (Legal Business Name): RAHUL S RISHI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E VIRGINIA AVE
PHOENIX AZ
85004-1208
US

IV. Provider business mailing address

348 E VIRGINIA AVE
PHOENIX AZ
85004-1208
US

V. Phone/Fax

Practice location:
  • Phone: 480-702-2020
  • Fax: 480-702-2112
Mailing address:
  • Phone: 480-702-2020
  • Fax: 480-702-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number005978
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: