Healthcare Provider Details

I. General information

NPI: 1144621012
Provider Name (Legal Business Name): DEEPTHI GANDHIRAJ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 S AVENUE B BLDG 20
YUMA AZ
85364-7726
US

IV. Provider business mailing address

3333 PRESTON RD STE 300
FRISCO TX
75034-9013
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-2434
  • Fax:
Mailing address:
  • Phone: 281-468-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberT4365
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number77123
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036177865
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036177865
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberT4365
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number77123
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: