Healthcare Provider Details

I. General information

NPI: 1558691634
Provider Name (Legal Business Name): PREEYA GOVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD BUILDING C, 1ST FLOOR
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD BUILDING C, 1ST FLOOR
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-2923
  • Fax: 602-933-0806
Mailing address:
  • Phone: 602-933-2923
  • Fax: 602-933-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR71378
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: