Individual
VINEE SRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3411 N 5TH AVE., STE 209, REGIONAL ADMIN OFFICE, PHOENIX, AZ 85013-3812
(602) 789-0344
(602) 789-8389
Mailing address
3411 N 5TH AVE., STE. 209, REGIONAL ADMIN OFFICE, PHOENIX, AZ 85013-3812
(602) 789-0344
(602) 789-8389
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35930
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112867
MEDICARE-TYPE UNSPECIFIED
AZ
05
—
177262
—
AZ
01
—
Z112869
MEDICARE-TYPE UNSPECIFIED
AZ
Enumeration date
01/18/2007
Last updated
07/10/2018
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