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General NPI Number Information
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NPI Number | 1285945758
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Entity Type | Individual
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Provider Name | REVATI MUMMANENI M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 4400 N SCOTTSDALE RD STE 9841
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-3331
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Country | US
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Telephone | 248-390-4503
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 N SCOTTSDALE RD STE 9841
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-3331
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R71974
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 50905
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License Number State | AZ
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