Healthcare Provider Details

I. General information

NPI: 1407474562
Provider Name (Legal Business Name): PRAVALIKA RUDRARAJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

IV. Provider business mailing address

1625 N CAMPBELL AVE
TUCSON AZ
85719-4330
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-0111
  • Fax: 520-694-6204
Mailing address:
  • Phone: 520-694-0111
  • Fax: 520-694-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU1556
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351046414
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberU1556
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79281
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: