Provider Demographics
NPI:1497118889
Name:VAHDANI, GOLNAZ (MD)
Entity Type:Individual
Prefix:
First Name:GOLNAZ
Middle Name:
Last Name:VAHDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 E CAMELBACK RD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2396
Mailing Address - Country:US
Mailing Address - Phone:602-997-0484
Mailing Address - Fax:602-943-1453
Practice Address - Street 1:6622 N 91ST AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2569
Practice Address - Country:US
Practice Address - Phone:623-547-4668
Practice Address - Fax:623-535-7869
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63698207RN0300X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGV3232267556Medicaid
CAGV3232267556OtherMEDICAID
AZ095882Medicaid