Provider Demographics
NPI:1962748574
Name:VARTEVAN, ALYSHA KEREN (DO)
Entity type:Individual
Prefix:DR
First Name:ALYSHA
Middle Name:KEREN
Last Name:VARTEVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 E LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3028
Mailing Address - Country:US
Mailing Address - Phone:407-340-0815
Mailing Address - Fax:
Practice Address - Street 1:4130 E VAN BUREN ST STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6996
Practice Address - Country:US
Practice Address - Phone:602-244-2442
Practice Address - Fax:602-244-2445
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS129012085R0202X
AZ0071672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology