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General NPI Number Information
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NPI Number | 1396407268
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Entity Type | Organization
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Legal Business Name | ROSE PSYCHIATRY
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 3755 S ROME ST
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City | GILBERT
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State | AZ
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Zip | 85297-7361
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Country | US
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Telephone | 480-631-9589
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Fax |
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Provider Business Mailing Address
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Address Line | 67 S HIGLEY RD STE 103-183
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City | GILBERT
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State | AZ
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Zip | 85296-1166
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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 | OWNER
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Name | KHALID SALIM KHAN
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Credential | MD
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Telephone | 480-510-8019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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