Provider Demographics
NPI:1740513241
Name:JAMBUSARIA, HEMALI TUSHAR (EDS)
Entity type:Individual
Prefix:MISS
First Name:HEMALI
Middle Name:TUSHAR
Last Name:JAMBUSARIA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E BROADWAY RD
Mailing Address - Street 2:APT 2083
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1640
Mailing Address - Country:US
Mailing Address - Phone:562-659-0414
Mailing Address - Fax:
Practice Address - Street 1:1500 E BROADWAY RD
Practice Address - Street 2:APT 2083
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1640
Practice Address - Country:US
Practice Address - Phone:562-659-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4203809174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist