Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 005629 | AZ |
N | 2081P2900X | Pain Medicine | OS9551 | FL |
NPI | 1003848904 |
---|---|
Provider Name | Dr. Vibhooti Harshavardhan Dave |
First Address | Scottsdale, AZ 85258-5068 |
Second Address | Scottsdale, AZ 85258-5068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 27/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16247 | BLUE CROSS BLUE SHIELD FL (01) | FL |
4295190001 | PALMETTO (01) | FL |
I40434 | (02) | FL |
P00262200 | RAILROAD MEDICARE (01) | FL |