Individual
VIJAY SAM NETHALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.B.B.S
Contact information
Practice address
6200 N LA CHOLLA BLVD, TUCSON, AZ 85741-3529
(575) 386-9110
Mailing address
8323 N SHANNON RD, TUCSON, AZ 85742-9597
(703) 966-4293
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
R80442
AZ
Other
Enumeration date
07/07/2023
Last updated
07/07/2023
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