1003848904 NPI number — DR. VIBHOOTI HARSHAVARDHAN DAVE D.O.

Table of content: KATHLEEN MILBERGER R.N. (NPI 1174898472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003848904 NPI number — DR. VIBHOOTI HARSHAVARDHAN DAVE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVE
Provider First Name:
VIBHOOTI
Provider Middle Name:
HARSHAVARDHAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003848904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9735 N. 90TH PLACE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-5068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-953-9500
Provider Business Mailing Address Fax Number:
602-953-1782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9735 N. 90TH PLACE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-5068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-953-9500
Provider Business Practice Location Address Fax Number:
602-953-1782
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  OS9551 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 005629 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4295190001 . This is a "PALMETTO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00262200 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 16247 . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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