Individual
DR. RAJA SIREESHA GHANTASALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBBS
Contact information
Practice address
1925 W ORANGE GROVE RD STE 109, TUCSON, AZ 85704-1150
(520) 751-3675
(520) 547-5767
Mailing address
5055 E BROADWAY BLVD STE A100, TUCSON, AZ 85711-3629
(520) 327-0460
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
73122
AZ
Other
Enumeration date
04/26/2021
Last updated
12/19/2024
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