Healthcare Provider Details

I. General information

NPI: 1376813162
Provider Name (Legal Business Name): YULIA K. KOLTZOVA-RANG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST 801
SAN FRANCISCO CA
94118-1522
US

IV. Provider business mailing address

10900 N SCOTTSDALE RD STE 102
SCOTTSDALE AZ
85254-5222
US

V. Phone/Fax

Practice location:
  • Phone: 650-343-8969
  • Fax:
Mailing address:
  • Phone: 480-609-8600
  • Fax: 480-922-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA70575
License Number StateCA

VIII. Authorized Official

Name: DR. YULIA K KOLTZOVA-RANG
Title or Position: PRESIDENT
Credential: MD
Phone: 650-343-8969