Healthcare Provider Details

I. General information

NPI: 1487603569
Provider Name (Legal Business Name): VIJAYA SATEESH NABAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST SUITE 121
PHOENIX AZ
85032-3345
US

IV. Provider business mailing address

16601 N 40TH ST SUITE 121
PHOENIX AZ
85032-3345
US

V. Phone/Fax

Practice location:
  • Phone: 602-992-3100
  • Fax: 602-992-9259
Mailing address:
  • Phone: 602-992-3100
  • Fax: 602-992-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number12581
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: