Healthcare Provider Details

I. General information

NPI: 1558634212
Provider Name (Legal Business Name): VISHWABANDHU J. JHAVERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VISHU J JHAVERI M.D.

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 N 23RD AVE BUILDING # 1
PHOENIX AZ
85021-4872
US

IV. Provider business mailing address

8220 N 23RD AVE BUILDING # 1
PHOENIX AZ
85021-4872
US

V. Phone/Fax

Practice location:
  • Phone: 602-864-4541
  • Fax:
Mailing address:
  • Phone: 602-864-4541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43322
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0029150
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: