Provider Demographics
NPI:1922284579
Name:BOOTWALA, YASMIN I (MD)
Entity Type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:I
Last Name:BOOTWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:480-855-2224
Mailing Address - Fax:480-398-8080
Practice Address - Street 1:6525 W SACK DR STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:602-337-8500
Practice Address - Fax:602-337-8151
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47818208800000X
TXP0170208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ881079Medicaid
AZ074851Medicaid
TX284518201Medicaid
TX284518201Medicaid