Healthcare Provider Details

I. General information

NPI: 1558316398
Provider Name (Legal Business Name): DEVYANI SUBHASH RAVAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 E ERICKSON DR #103
TUCSON AZ
85712-2838
US

IV. Provider business mailing address

6110 N CAMINO DE MICHAEL
TUCSON AZ
85718-2716
US

V. Phone/Fax

Practice location:
  • Phone: 529-292-0727
  • Fax:
Mailing address:
  • Phone: 520-297-0809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number19390
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: