Provider Demographics
NPI:1750603213
Name:ORO VALLEY NEUROLOGY PLLC
Entity type:Organization
Organization Name:ORO VALLEY NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-544-5556
Mailing Address - Street 1:1521 E TANGERINE RD
Mailing Address - Street 2:SUITE # 291
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-6225
Mailing Address - Country:US
Mailing Address - Phone:520-544-5556
Mailing Address - Fax:520-544-5619
Practice Address - Street 1:1521 E TANGERINE RD
Practice Address - Street 2:SUITE 291
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6225
Practice Address - Country:US
Practice Address - Phone:520-544-5556
Practice Address - Fax:520-544-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ888323Medicaid
AZ888323Medicaid