Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 59666 | AZ |
NPI | 1316353873 |
---|---|
Provider Name | Soumya Nagaraja |
First Address | Mesa, AZ 85202-4745 |
Second Address | Mesa, AZ 85202-6770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2014 |
Last Update Date | 08/06/2020 |