Healthcare Provider Details

I. General information

NPI: 1225015159
Provider Name (Legal Business Name): SHIRAZ H LADHA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 N 7TH ST SUITE G114
PHOENIX AZ
85022-4382
US

IV. Provider business mailing address

14001 N 7TH ST SUITE G114
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 Code261Q00000X
TaxonomyClinic/Center
License Number16757
License Number StateAZ

VIII. Authorized Official

Name: DR. SHIRAZ H LADHA
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 602-298-6930