Healthcare Provider Details

I. General information

NPI: 1073772588
Provider Name (Legal Business Name): EVAC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 04/27/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2394 N ALMA SCHOOL RD STE 1
CHANDLER AZ
85224-2459
US

IV. Provider business mailing address

612 W BASELINE RD
MESA AZ
85210-6041
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-0700
  • Fax: 480-776-5737
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANINDER CHATHA
Title or Position: OWNER
Credential: MD
Phone: 480-834-9039