Provider Demographics
NPI:1003848904
Name:DAVE, VIBHOOTI HARSHAVARDHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:VIBHOOTI
Middle Name:HARSHAVARDHAN
Last Name:DAVE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 N. 90TH PLACE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5068
Mailing Address - Country:US
Mailing Address - Phone:602-953-9500
Mailing Address - Fax:602-953-1782
Practice Address - Street 1:9735 N. 90TH PLACE
Practice Address - Street 2:SUITE 301
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5068
Practice Address - Country:US
Practice Address - Phone:602-953-9500
Practice Address - Fax:602-953-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS95512081P2900X
AZ0056292081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4295190001OtherPALMETTO
FLP00262200OtherRAILROAD MEDICARE
FL16247OtherBLUE CROSS BLUE SHIELD FL
FLI40434Medicare UPIN
FL4295190001OtherPALMETTO