Provider Demographics
NPI:1912575093
Name:RD INTEGRATED HEALTH PLLC
Entity Type:Organization
Organization Name:RD INTEGRATED HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/MANAGER AND MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MALAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-261-5258
Mailing Address - Street 1:5519 W BANFF LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3045
Mailing Address - Country:US
Mailing Address - Phone:623-261-5258
Mailing Address - Fax:
Practice Address - Street 1:5519 W BANFF LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3045
Practice Address - Country:US
Practice Address - Phone:623-261-5258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care