Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 7229 | AZ |
N | 225100000X | Physical Therapist | 4078 | AZ |
NPI | 1013123264 |
---|---|
Provider Name | Dr. Tare C Gurira |
First Address | Chandler, AZ 85224-3485 |
Second Address | Gilbert, AZ 85296-3445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AZ0942740 | BLUE CROSS BLUE SHIELD (01) | AZ |