Individual
NIREK RASTOGI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11030 N TATUM BLVD, STE 101, PHOENIX, AZ 85028-6073
(602) 687-8265
Mailing address
PO BOX 31853, PHOENIX, AZ 85046-1853
(602) 687-8265
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36997
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253109
—
AZ
Enumeration date
08/29/2006
Last updated
03/24/2010
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