Provider Demographics
NPI:1396056131
Name:ALLERY AND ASTHMA CENTER OF ARIZONA PLC
Entity type:Organization
Organization Name:ALLERY AND ASTHMA CENTER OF ARIZONA PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAO
Authorized Official - Middle Name:RAJ
Authorized Official - Last Name:KOSARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-855-0664
Mailing Address - Street 1:633 E RAY RD
Mailing Address - Street 2:101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4200
Mailing Address - Country:US
Mailing Address - Phone:480-855-0664
Mailing Address - Fax:480-222-4684
Practice Address - Street 1:633 E RAY RD
Practice Address - Street 2:101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4200
Practice Address - Country:US
Practice Address - Phone:480-855-0664
Practice Address - Fax:480-222-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-26
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43123207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty