Provider Demographics
NPI:1639910060
Name:RAUDALES, SURI ZADAI (NP)
Entity type:Individual
Prefix:
First Name:SURI
Middle Name:ZADAI
Last Name:RAUDALES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SURI
Other - Middle Name:ZADAI
Other - Last Name:OROZCO-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11361 N 99TH AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11361 N 99TH AVE STE 402
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-5459
Practice Address - Country:US
Practice Address - Phone:602-636-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP236409363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health