Provider Demographics
NPI:1699825885
Name:RUBBANI, SOOFIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOOFIA
Middle Name:
Last Name:RUBBANI
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 1:1230 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3156
Mailing Address - Country:US
Mailing Address - Phone:520-389-8080
Mailing Address - Fax:520-639-6531
Practice Address - Street 1:1230 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3156
Practice Address - Country:US
Practice Address - Phone:520-389-8080
Practice Address - Fax:520-639-6531
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43494207W00000X, 207WX0200X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ726380Medicaid