Provider Demographics
NPI:1770256083
Name:MANTENA, ANURADHA (MD)
Entity Type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:MANTENA
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 1:10503 W THUNDERBIRD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3047
Mailing Address - Country:US
Mailing Address - Phone:623-974-3649
Mailing Address - Fax:623-974-8364
Practice Address - Street 1:10503 W THUNDERBIRD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3047
Practice Address - Country:US
Practice Address - Phone:623-974-3649
Practice Address - Fax:623-974-8364
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE34144207RN0300X
AZR79129207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology