Healthcare Provider Details

I. General information

NPI: 1932620507
Provider Name (Legal Business Name): DR. DEEPA RAHUL MANDALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2017
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

755 E MCDOWELL RD
PHOENIX AZ
85006-2506
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-3090
  • Fax: 602-521-3661
Mailing address:
  • Phone: 602-521-3090
  • Fax: 602-521-3661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number60198
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: