Provider Demographics
NPI:1245470293
Name:ANDUJAR, JOANNA (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:ANDUJAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:ANDUJAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2510 W DUNLAP AVE
Mailing Address - Street 2:STE 290
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2737
Mailing Address - Country:US
Mailing Address - Phone:602-789-0344
Mailing Address - Fax:602-789-8389
Practice Address - Street 1:2510 W DUNLAP AVE
Practice Address - Street 2:STE 290
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2737
Practice Address - Country:US
Practice Address - Phone:602-789-0344
Practice Address - Fax:602-789-8389
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ47336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ838375Medicaid