Basic Information
| Provider Information | |||||||||
| NPI: | 1154556900 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DESERT CANYON INTERNAL MEDICINE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4802 E RAY RD | ||||||||
| Address2: | # 23-117 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850446405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024396780 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7400 E OSBORN RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022256262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2009 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | JAFARI-RASKE | ||||||||
| AuthorizedOfficialFirstName: | GITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6022256262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.