Healthcare Provider Details

I. General information

NPI: 1295229672
Provider Name (Legal Business Name): YUMA KIDNEY & DIALYSIS SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11518 N FRONTAGE RD STE A
YUMA AZ
85367-8994
US

IV. Provider business mailing address

PO BOX 669
YUMA AZ
85366-2329
US

V. Phone/Fax

Practice location:
  • Phone: 928-342-6500
  • Fax:
Mailing address:
  • Phone: 928-247-6516
  • Fax: 928-366-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. IRFAN FAZIL
Title or Position: CEO
Credential: MD
Phone: 928-366-7364