Provider Demographics
NPI:1245476092
Name:RAJIV KWATRA MD PC
Entity type:Organization
Organization Name:RAJIV KWATRA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:KWATRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD-PC
Authorized Official - Phone:602-230-6744
Mailing Address - Street 1:1331 N 7TH ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2754
Mailing Address - Country:US
Mailing Address - Phone:602-230-6744
Mailing Address - Fax:
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:SUITE 290
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-230-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25383302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ63157Medicare UPIN