Provider Demographics
NPI:1528133170
Name:KOLTZOVA-RANG, YULIA K (MD)
Entity type:Individual
Prefix:
First Name:YULIA
Middle Name:K
Last Name:KOLTZOVA-RANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 N SCOTTSDALE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5222
Mailing Address - Country:US
Mailing Address - Phone:480-609-8600
Mailing Address - Fax:480-922-4966
Practice Address - Street 1:10900 N SCOTTSDALE RD STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5222
Practice Address - Country:US
Practice Address - Phone:480-609-8600
Practice Address - Fax:480-922-4966
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70575207R00000X
AZAZ55761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A705750Medicaid
942463139OtherTAX ID
CAH38797Medicare UPIN
CA00A705750Medicaid