Healthcare Provider Details

I. General information

NPI: 1255295994
Provider Name (Legal Business Name): SANOVA PHYSICAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15883 N ORACLE RD
TUCSON AZ
85739-9202
US

IV. Provider business mailing address

PO BOX 89520
TUCSON AZ
85752-9520
US

V. Phone/Fax

Practice location:
  • Phone: 520-404-5356
  • Fax:
Mailing address:
  • Phone: 520-404-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: KIYAN RAD
Title or Position: OWNER
Credential: MD
Phone: 520-404-5356