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General NPI Number Information
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NPI Number | 1861737173
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Entity Type | Organization
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Legal Business Name | AVANIHEALTHCLINIC PC
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 13000 N 103RD AVE STE 96
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City | SUN CITY
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State | AZ
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Zip | 85351-3060
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Country | US
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Telephone | 623-974-8555
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Fax | 623-583-6461
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Provider Business Mailing Address
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Address Line | 13000 N 103RD AVE STE 96
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City | SUN CITY
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State | AZ
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Zip | 85351-3060
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Country | US
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Telephone | 623-974-8555
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Fax | 623-583-6461
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAMA VASIREDDY
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Credential | M.D;
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Telephone | 623-974-8555
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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 | 28052
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License Number State | AZ
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