Healthcare Provider Details

I. General information

NPI: 1144310541
Provider Name (Legal Business Name): DEBRA K VENKATESH AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 E SOUTHERN AVE SUITE 21
TEMPE AZ
85282-7669
US

IV. Provider business mailing address

2501 E SOUTHERN AVE SUITE 21
TEMPE AZ
85282-7669
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-4330
  • Fax: 480-833-1902
Mailing address:
  • Phone: 480-833-4330
  • Fax: 480-833-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberDA1670
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: