Healthcare Provider Details

I. General information

NPI: 1538171723
Provider Name (Legal Business Name): REENA D. JAIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14275 N 87TH ST SUITE 110
SCOTTSDALE AZ
85260-3696
US

IV. Provider business mailing address

14275 N 87TH ST SUITE 110
SCOTTSDALE AZ
85260-3696
US

V. Phone/Fax

Practice location:
  • Phone: 480-905-8485
  • Fax: 480-905-7274
Mailing address:
  • Phone: 480-905-8485
  • Fax: 480-905-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2678
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: