Healthcare Provider Details

I. General information

NPI: 1386814945
Provider Name (Legal Business Name): USHA VENKATARAMANAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W VALENCIA RD STE 110
TUCSON AZ
85746-6006
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A-100 ARIZONA COMMUNITY PHYSICIANS
TUCSON AZ
85711-3629
US

V. Phone/Fax

Practice location:
  • Phone: 520-751-3312
  • Fax: 520-547-5785
Mailing address:
  • Phone: 520-547-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40791
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: