Individual
NURUL ITQIYAH HARIADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
17900 N PORTER RD, MARICOPA, AZ 85138-4228
(520) 233-2500
(520) 233-2574
Mailing address
17900 N PORTER RD, MARICOPA, AZ 85138-4228
(520) 233-2500
(520) 233-2574
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301090456
MI
Other
Enumeration date
11/15/2007
Last updated
07/22/2016
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