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General NPI Number Information
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NPI Number | 1295229672
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Entity Type | Organization
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Legal Business Name | YUMA KIDNEY & DIALYSIS SPECIALISTS PC
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 11518 N FRONTAGE RD STE A
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City | YUMA
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State | AZ
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Zip | 85367-8994
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Country | US
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Telephone | 928-342-6500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | YUMA
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State | AZ
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Zip | 85366-2329
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Country | US
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Telephone | 928-247-6516
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Fax | 928-366-1075
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Authorized Official
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Title or Position | CEO
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Name | DR. IRFAN FAZIL
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Credential | MD
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Telephone | 928-366-7364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State | AZ
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