Provider Demographics
NPI:1336132596
Name:GULAYA, DEVENDRA V (MD)
Entity Type:Individual
Prefix:MR
First Name:DEVENDRA
Middle Name:V
Last Name:GULAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 W MCDOWELL RD
Mailing Address - Street 2:BLDG N1445
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4863
Mailing Address - Country:US
Mailing Address - Phone:623-547-2100
Mailing Address - Fax:623-547-3005
Practice Address - Street 1:10320 W MCDOWELL RD
Practice Address - Street 2:BLDG N1445
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-4863
Practice Address - Country:US
Practice Address - Phone:623-547-2100
Practice Address - Fax:623-547-3005
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ474461Medicaid
AZ73229Medicare ID - Type UnspecifiedGROUP #
AZ474461Medicaid
AZ103314Medicare PIN