Provider Demographics
NPI:1518250224
Name:APNNA - ARIZONA PEDIATRIC NEUROLOGY & NEUROGENETICS ASSOCIATES
Entity Type:Organization
Organization Name:APNNA - ARIZONA PEDIATRIC NEUROLOGY & NEUROGENETICS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINODH
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAYANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-406-6380
Mailing Address - Street 1:PO BOX 39385
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-9385
Mailing Address - Country:US
Mailing Address - Phone:602-406-6380
Mailing Address - Fax:602-406-4067
Practice Address - Street 1:222 W THOMAS RD
Practice Address - Street 2:SUITE 406
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4419
Practice Address - Country:US
Practice Address - Phone:602-406-6380
Practice Address - Fax:602-406-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ311012084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ784365Medicaid
AZC57753Medicare UPIN
AZ78067Medicare PIN