Healthcare Provider Details

I. General information

NPI: 1497338883
Provider Name (Legal Business Name): ISHANI JOSHI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2805
US

IV. Provider business mailing address

22520 N 37TH TER
PHOENIX AZ
85050-7376
US

V. Phone/Fax

Practice location:
  • Phone: 520-440-0963
  • Fax:
Mailing address:
  • Phone: 602-502-2936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR3581
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: