Provider Demographics
NPI:1982936753
Name:REBECCA PRADHAN- NARA
Entity Type:Organization
Organization Name:REBECCA PRADHAN- NARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADHAN-NARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-226-4338
Mailing Address - Street 1:77 CALLE PORTAL
Mailing Address - Street 2:SUITE B260A
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2967
Mailing Address - Country:US
Mailing Address - Phone:520-226-4338
Mailing Address - Fax:886-479-4841
Practice Address - Street 1:77 CALLE PORTAL
Practice Address - Street 2:SUITE B260A
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2967
Practice Address - Country:US
Practice Address - Phone:520-226-4338
Practice Address - Fax:886-479-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72197Medicare UPIN