Healthcare Provider Details

I. General information

NPI: 1528133170
Provider Name (Legal Business Name): YULIA K KOLTZOVA-RANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 N SCOTTSDALE RD STE 102
SCOTTSDALE AZ
85254-5222
US

IV. Provider business mailing address

10900 N SCOTTSDALE RD STE 102
SCOTTSDALE AZ
85254-5222
US

V. Phone/Fax

Practice location:
  • Phone: 480-609-8600
  • Fax: 480-922-4966
Mailing address:
  • Phone: 480-609-8600
  • Fax: 480-922-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA70575
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAZ55761
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: