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General NPI Number Information
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NPI Number | 1962748574
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Entity Type | Individual
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Provider Name | ALYSHA KEREN VARTEVAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 4130 E VAN BUREN ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85008-6996
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Country | US
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Telephone | 602-244-2442
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Fax | 602-244-2445
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Provider Business Mailing Address
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Address Line | 6040 E LAFAYETTE BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-3028
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Country | US
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Telephone | 407-340-0815
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | OS12901
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 007167
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License Number State | AZ
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