Basic Information
Provider Information | |||||||||
NPI: | 1285834812 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PUGAZHENDHI | ||||||||
FirstName: | THIRIPURASUNDARI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PUGAZHENDHI | ||||||||
OtherFirstName: | THIRIPURASUNDARI | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 5530 N VIA UMBROSA | ||||||||
Address2: |   | ||||||||
City: | TUCSON | ||||||||
State: | AZ | ||||||||
PostalCode: | 857506462 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5202964690 | ||||||||
FaxNumber: | 5203004991 | ||||||||
Practice Location | |||||||||
Address1: | 3600 S 6TH AVENUE | ||||||||
Address2: |   | ||||||||
City: | TUCSON | ||||||||
State: | AZ | ||||||||
PostalCode: | 857235154 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5206294606 | ||||||||
FaxNumber: | 5208383656 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/22/2007 | ||||||||
LastUpdateDate: | 11/15/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0009X | 46811 | AZ | Y |   |   |   |   |
ID Information
ID | Type | State | Issuer | Description | 930958 | 05 | AZ |   | MEDICAID | Z 171853 | 01 | AZ | MEDICARE | OTHER |