Healthcare Provider Details

I. General information

NPI: 1477789170
Provider Name (Legal Business Name): SAGUARO INTERNAL MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14506 W GRANITE VALLEY DR STE 225
SUN CITY WEST AZ
85375-6010
US

IV. Provider business mailing address

14506 W GRANITE VALLEY DR STE 225
SUN CITY WEST AZ
85375-6010
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-0007
  • Fax: 623-584-6915
Mailing address:
  • Phone: 623-546-0007
  • Fax: 623-584-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD22681
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberMD22681
License Number StateAZ

VIII. Authorized Official

Name: MS. SATYA SARMA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 623-546-0007