Healthcare Provider Details

I. General information

NPI: 1700062650
Provider Name (Legal Business Name): SHIRAZ H LADHA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 N 7TH ST BUILDING G, SUITE 114
PHOENIX AZ
85022-4382
US

IV. Provider business mailing address

14001 N 7TH ST BUILDING G, SUITE 114
PHOENIX AZ
85022-4382
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-6930
  • Fax: 602-298-6918
Mailing address:
  • Phone: 602-298-6930
  • Fax: 602-298-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: