Provider Demographics
NPI:1164116174
Name:RAMINI, SANTHOSH KUMAR (PA)
Entity Type:Individual
Prefix:
First Name:SANTHOSH
Middle Name:KUMAR
Last Name:RAMINI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 S STAPLEY DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5850
Mailing Address - Country:US
Mailing Address - Phone:480-633-1111
Mailing Address - Fax:480-633-6611
Practice Address - Street 1:1455 S STAPLEY DR STE 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5850
Practice Address - Country:US
Practice Address - Phone:480-633-1111
Practice Address - Fax:480-633-6611
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ9720363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical