Individual
MANJUL SRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6060 N FOUNTAIN PLAZA DR, SUITE 270, TUCSON, AZ 85704-7870
(520) 229-2578
Mailing address
6060 N FOUNTAIN PLAZA DR, SUITE 270, TUCSON, AZ 85704-7870
(520) 229-2578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35504
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111163
—
AZ
01
—
35504
MD LIC
AZ
Enumeration date
06/11/2006
Last updated
11/28/2022
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