Basic Information
| Provider Information | |||||||||
| NPI: | 1306266192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REKHALA | ||||||||
| FirstName: | VILASINI | ||||||||
| MiddleName: | VIDNYA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9059 W. LAKE PLEASANT PKWY | ||||||||
| Address2: | STE E-540 | ||||||||
| City: | PEONA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233223380 | ||||||||
| FaxNumber: | 6233224399 | ||||||||
| Practice Location | |||||||||
| Address1: | 9059 W. LAKE PLEASANT PKWY | ||||||||
| Address2: | STE E-540 | ||||||||
| City: | PEONA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233223380 | ||||||||
| FaxNumber: | 6233224399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 54764 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.