Provider Demographics
NPI:1174773717
Name:PODUVAL, ARUNA DIVAKARAN (MD)
Entity type:Individual
Prefix:
First Name:ARUNA
Middle Name:DIVAKARAN
Last Name:PODUVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2204 S DOBSON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6457
Mailing Address - Country:US
Mailing Address - Phone:480-757-6457
Mailing Address - Fax:480-378-7090
Practice Address - Street 1:2204 S DOBSON RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-757-6457
Practice Address - Fax:480-378-7090
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ494202080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ961725Medicaid