1093380941 NPI number — VASCULAR INSTITUTE OF ARIZONA PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093380941 NPI number — VASCULAR INSTITUTE OF ARIZONA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR INSTITUTE OF ARIZONA PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1093380941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 S ALMA SCHOOL RD STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85286-7076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-936-7722
Provider Business Mailing Address Fax Number:
480-936-7723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21321 E OCOTILLO RD STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEEN CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85142-5995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-936-7722
Provider Business Practice Location Address Fax Number:
480-936-7723
Provider Enumeration Date:
05/24/2021

Additional Information

Authorized Official

Authorized Official Last Name:
BALRAJ
Authorized Official First Name:
PRAVEEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEMBER MANAGER
Authorized Official Telephone Number:
480-936-7722

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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