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General NPI Number Information
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NPI Number | 1275840027
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Entity Type | Organization
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Legal Business Name | DR S GUNNALA MD PC
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 19636 N 27TH AVE STE 207
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City | PHOENIX
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State | AZ
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Zip | 85027-4015
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Country | US
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Telephone | 623-580-7245
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Fax | 602-864-1401
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Provider Business Mailing Address
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Address Line | 19636 N 27TH AVE STE 207
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City | PHOENIX
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State | AZ
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Zip | 85027-4015
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Country | US
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Telephone | 623-580-7245
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Fax | 602-864-1401
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MR. SHAUN KANAKA
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Credential | MBA
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Telephone | 480-225-3065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 27607
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License Number State | AZ
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