Organization
BJD INC
Active
Other names
Radiant Adult Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIVYR DERAKHSHAN (PRESIDENT)
(928) 483-9911
Entity
Organization
Contact information
Practice address
1025 W 24TH ST STE 26, YUMA, AZ 85364-8372
(928) 318-6910
(928) 328-1056
Mailing address
1025 W 24TH ST STE 26, YUMA, AZ 85364-8372
(928) 318-6910
(928) 328-1056
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/12/2019
Last updated
09/13/2024
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