Healthcare Provider Details

I. General information

NPI: 1003848904
Provider Name (Legal Business Name): VIBHOOTI HARSHAVARDHAN DAVE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 N. 90TH PLACE SUITE 301
SCOTTSDALE AZ
85258-5068
US

IV. Provider business mailing address

9735 N. 90TH PLACE SUITE 301
SCOTTSDALE AZ
85258-5068
US

V. Phone/Fax

Practice location:
  • Phone: 602-953-9500
  • Fax: 602-953-1782
Mailing address:
  • Phone: 602-953-9500
  • Fax: 602-953-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS9551
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number005629
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: