Healthcare Provider Details

I. General information

NPI: 1376881177
Provider Name (Legal Business Name): RAJAN KAPOOR MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 03/07/2023
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 E WARNER RD STE 101
TEMPE AZ
85284-3495
US

IV. Provider business mailing address

2149 E WARNER RD STE 101
TEMPE AZ
85284-3495
US

V. Phone/Fax

Practice location:
  • Phone: 804-610-6100
  • Fax: 480-464-0189
Mailing address:
  • Phone: 804-610-6100
  • Fax: 480-464-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number069299
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: