Provider Demographics
NPI:1912575093
Name:RD INTEGRATED HEALTH PLLC
Entity type:Organization
Organization Name:RD INTEGRATED HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP/MANAGER AND MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, AGACNP, PMHNP
Authorized Official - Phone:623-261-5258
Mailing Address - Street 1:5519 W BANFF LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3045
Mailing Address - Country:US
Mailing Address - Phone:623-261-5258
Mailing Address - Fax:
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 202
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4712
Practice Address - Country:US
Practice Address - Phone:623-301-9992
Practice Address - Fax:623-432-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care