Favata, Kelli Raynell

Favata, Kelli Raynell is an individual health care provider with primary practice located at 3420 S Mercy Rd Ste 211 , Gilbert AZ 85297-0424. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Technologists, Technicians & Other Technical Service Providers / Vascular Specialist. Technologists, Technicians & Other Technical Service Providers / Vascular Specialist is her primary health care specialty. Favata, Kelli Raynell can be contacted via phone (866) 974-2673.

Contact Information

Primary practice address
3420 S Mercy Rd Ste 211 Gilbert AZ 85297-0424
Phone: (866) 974-2673
Fax: (866) 939-2673
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 45344 Arizona
Technologists, Technicians & Other Technical Service Providers / Vascular Specialist 246XC2903X 45344 Arizona
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 30177 South Carolina

Profile Details

NPI number 1184822348
LBN Legal business name Favata, Kelli Raynell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 10th, 2007
Last updated Sep 30th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184822348 NPPES
Arizona MEDICAID 654974

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