Provider Demographics
NPI:1679071534
Name:SOVANI PLLC
Entity type:Organization
Organization Name:SOVANI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANTWANA
Authorized Official - Middle Name:VINAYAK
Authorized Official - Last Name:SOVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-771-0217
Mailing Address - Street 1:3685 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3943
Mailing Address - Country:US
Mailing Address - Phone:304-771-0217
Mailing Address - Fax:
Practice Address - Street 1:2270 S RIDGEVIEW DR STE 207
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8880
Practice Address - Country:US
Practice Address - Phone:928-783-4640
Practice Address - Fax:928-276-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37029207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ613012Medicaid