Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 008443 | AZ |
Y | 111NI0900X | Internist | 008443 | AZ |
NPI | 1003341835 |
---|---|
Provider Name | Ammad Raina |
First Address | Sierra Vista, AZ 85635-9110 |
Second Address | Sierra Vista, AZ 85635-9110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2017 |
Last Update Date | 07/09/2021 |