Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 6664 | AZ |
NPI | 1093733644 |
---|---|
Provider Name | Dr. Rumbha Virasoontara Bhandhusavee |
First Address | Glendale, AZ 85306-3715 |
Second Address | Glendale, AZ 85306-3715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |