Individual
CHANTAY BANIKARIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
222 W THOMAS RD, SUITE 301, PHOENIX, AZ 85013-4419
(602) 406-4772
Mailing address
FILE 56765, LOS ANGELES, CA 90074-6765
(602) 406-3860
(602) 406-6132
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
30080
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
761404
—
AZ
Enumeration date
08/30/2006
Last updated
04/24/2012
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