=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003168840
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAGA NALINI TIRUMALASETTY MD,ECNU,FACE.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2012
-----------------------------------------------------
Last Update Date | 09/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 W CHANDLER BLVD STE 4
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-269-6448
-----------------------------------------------------
Fax | 779-204-2331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 908 W CHANDLER BLVD STE 4
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-2548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-269-6448
-----------------------------------------------------
Fax | 779-204-2331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 2014001412
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 55238
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------