Healthcare Provider Details

I. General information

NPI: 1629690565
Provider Name (Legal Business Name): FASEEHA ARSHAD GONDAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date: 01/17/2022
Reactivation Date: 02/24/2022

III. Provider practice location address

350 N WILMOT RD
TUCSON AZ
85711-2602
US

IV. Provider business mailing address

350 N WILMOT RD
TUCSON AZ
85711-2602
US

V. Phone/Fax

Practice location:
  • Phone: 602-317-6837
  • Fax:
Mailing address:
  • Phone: 602-317-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79682
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61416032
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: