Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 34083 | AZ |
Y | 207RI0011X | Interventional Cardiology | 34083 | AZ |
NPI | 1003804170 |
---|---|
Provider Name | Manoj Rawal |
First Address | Peoria, AZ 85381-4246 |
Second Address | Peoria, AZ 85381-4246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 18/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
944018 | (05) | AZ |
G48680 | (02) | AZ |
P00263967 | MEDICARE RAIL ROAD (01) | AZ |
WCFKQ | SUN HEALTH PHYSICIANS (01) | AZ |