Healthcare Provider Details

I. General information

NPI: 1679520522
Provider Name (Legal Business Name): ARUNDATHI P. NARAYANAPPA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11034 N 23RD DR # 105B
PHOENIX AZ
85029-4743
US

IV. Provider business mailing address

4530 E RAY RD SUITE #190
PHOENIX AZ
85044-6094
US

V. Phone/Fax

Practice location:
  • Phone: 602-639-0189
  • Fax:
Mailing address:
  • Phone: 480-940-5420
  • Fax: 480-940-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2015
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: