Provider Demographics
NPI:1235132895
Name:NEYRA, ROXANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:
Last Name:NEYRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NILDA
Other - Middle Name:ROXANA
Other - Last Name:NEYRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6622 N 91ST AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3315
Practice Address - Street 1:3320 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-200-8288
Practice Address - Fax:602-200-8627
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25417207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ407389Medicaid
AZ65159Medicare PIN
AZ134477Medicare PIN
G43700Medicare UPIN
AZ407389Medicaid
AZ117560Medicare PIN
AZ117471Medicare PIN
AZ134864Medicare PIN