Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 49420 | AZ |
NPI | 1174773717 |
---|---|
Provider Name | Aruna Divakaran Poduval |
First Address | Mesa, AZ 85202-6457 |
Second Address | Mesa, AZ 85202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2008 |
Last Update Date | 01/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
961725 | (05) | AZ |