Healthcare Provider Details

I. General information

NPI: 1093811952
Provider Name (Legal Business Name): DINNA ROSENTHAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DINNA DE CASTRO

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 W THOMAS RD
PHOENIX AZ
85033-5700
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 1600
PHOENIX AZ
85012-2908
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 623-247-9742
Mailing address:
  • Phone: 602-323-3344
  • Fax: 602-323-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number208000000X
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54388
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: