Healthcare Provider Details

I. General information

NPI: 1649313917
Provider Name (Legal Business Name): ALLERGY & ASTHMA CARE OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 S AVENUE A SUITE 22
YUMA AZ
85364
US

IV. Provider business mailing address

PO BOX 25038
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-2300
  • Fax: 928-426-5085
Mailing address:
  • Phone: 480-609-7201
  • Fax: 480-502-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: KUDAGAL S MURTHY
Title or Position: PRINCIPAL PARTNER
Credential: MD
Phone: 480-608-7201