Provider Demographics
NPI:1336590082
Name:MUDHAR, NARINDER
Entity type:Individual
Prefix:
First Name:NARINDER
Middle Name:
Last Name:MUDHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 E SOUTHERN AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5036
Mailing Address - Country:US
Mailing Address - Phone:602-615-9687
Mailing Address - Fax:
Practice Address - Street 1:931 E SOUTHERN AVE STE 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5036
Practice Address - Country:US
Practice Address - Phone:602-615-9687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health