Healthcare Provider Details

I. General information

NPI: 1124298468
Provider Name (Legal Business Name): EAST VALLEY ALLERGY & ASTHMA CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 S MERCY RD SUITE #101
GILBERT AZ
85297-0433
US

IV. Provider business mailing address

3491 S MERCY RD SUITE #101
GILBERT AZ
85297-0433
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-9119
  • Fax: 480-855-9120
Mailing address:
  • Phone: 480-855-9119
  • Fax: 480-855-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number29731
License Number StateAZ

VIII. Authorized Official

Name: DR. DOINA L LAPUSAN
Title or Position: OWNER
Credential: M.D.
Phone: 480-855-9119