Vilasini Vidnya Rekhala, MD
Individual provider Active NPI Pediatrics Physician · Peona, AZ
NPI 1306266192 · NPPES record last updated May 5, 2022
Key facts
- NPI
- 1306266192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 54764 (AZ)
- Practice address
- 9059 W. Lake Pleasant Pkwy
Ste E-540
Peona, AZ 85382 - Phone
- (623) 322-3380
- Fax
- (623) 322-4399
- NPI assigned
- Apr 21, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250523002009 | AZ | Order and Referring Only - Pediatric Medicine |
3476858622 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54764 | AZ | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Banner Estrella Medical Center | Past | Accepting new patients | |
| Pleasant Pediatrics PLC | Pediatrics | Past |
Accepting new patients |
| Pleasant Pediatrics | Pediatrics | Past |
Accepting new patients |
| VHS of Arrowhead, Inc | Past | Accepting new patients | |
| Pleasant Pediatrics PLC | Pediatrics | Past | Accepting new patients |
| Pleasant Pediatrics PLC | Pediatrics | Past | Accepting new patients |
| Pleasant Pediatrics PLC | Pediatrics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 54764 | AZ | Yes |
Addresses
Primary practice location
9059 W. Lake Pleasant Pkwy
Ste E-540
Peona, AZ 85382
Mailing address
9059 W. Lake Pleasant Pkwy
Ste E-540
Peona, AZ 85382
Phone (623) 322-3380
Other providers in Peona, AZ
All providers in Peona, AZ · Pediatrics Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.