Healthcare Provider Details

I. General information

NPI: 1215227749
Provider Name (Legal Business Name): VINAY GUNNALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 N 32ND ST STE 200
PHOENIX AZ
85018-6218
US

IV. Provider business mailing address

3125 N 32ND ST STE 200
PHOENIX AZ
85018-6218
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-7481
  • Fax: 602-956-7591
Mailing address:
  • Phone: 602-956-7481
  • Fax: 602-956-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number56072
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: