Healthcare Provider Details

I. General information

NPI: 1548097975
Provider Name (Legal Business Name): HEENA KHATRI HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 E ACOMA DR STE 102
SCOTTSDALE AZ
85254-3550
US

IV. Provider business mailing address

4400 N SCOTTSDALE RD STE 9270
SCOTTSDALE AZ
85251-3331
US

V. Phone/Fax

Practice location:
  • Phone: 800-998-6096
  • Fax:
Mailing address:
  • Phone: 480-993-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD14214
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: