Healthcare Provider Details

I. General information

NPI: 1639151749
Provider Name (Legal Business Name): NAVAZ DOLASA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 W SEED FARM RD
SACATON AZ
85147-0038
US

IV. Provider business mailing address

PO BOX 38
SACATON AZ
85147-0038
US

V. Phone/Fax

Practice location:
  • Phone: 602-528-1200
  • Fax: 602-528-1225
Mailing address:
  • Phone: 602-528-1200
  • Fax: 602-528-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33070
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: