Basic Information
| Provider Information | |||||||||
| NPI: | 1750519732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOGAL | ||||||||
| FirstName: | SUVARNA | ||||||||
| MiddleName: | ASHISH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 E CAMELBACK RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850182327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029331814 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 S DOBSON RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852246183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809636668 | ||||||||
| FaxNumber: | 4809636669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 125-056509 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 46216 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.