Individual
DR. KELLI RAYNELL FAVATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3530 S VAL VISTA DR STE B210, GILBERT, AZ 85297-7318
(800) 991-6117
Mailing address
3820 NORTHDALE BLVD STE 201, TAMPA, FL 33624-1893
(800) 911-6117
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
30177
SC
207R00000X
Internal Medicine Physician
45344
AZ
246XC2903X
Vascular Specialist/Technologist Cardiovascular
Primary
45344
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
654974
—
AZ
Enumeration date
07/10/2007
Last updated
02/15/2025
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