Provider Demographics
NPI:1952839979
Name:SCOTTSDALE PERSONAL OBGYN PLLC
Entity Type:Organization
Organization Name:SCOTTSDALE PERSONAL OBGYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-794-1000
Mailing Address - Street 1:PO BOX 12254
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-2254
Mailing Address - Country:US
Mailing Address - Phone:480-794-1000
Mailing Address - Fax:480-585-0828
Practice Address - Street 1:14220 N NORTHSIGHT BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3950
Practice Address - Country:US
Practice Address - Phone:480-794-1000
Practice Address - Fax:480-585-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44786261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA013845Medicaid