Healthcare Provider Details

I. General information

NPI: 1386816668
Provider Name (Legal Business Name): EAST VALLEY PAIN CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 E BOSTON ST SUITE 101
GILBERT AZ
85295-6236
US

IV. Provider business mailing address

224 N FAIR OAKS AVE STE 300
PASADENA CA
91103-3618
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-0057
  • Fax: 480-632-1237
Mailing address:
  • Phone: 626-696-1400
  • Fax: 626-696-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number22099
License Number StateAZ

VIII. Authorized Official

Name: CLAYTON A VARGA
Title or Position: CEO
Credential: MD
Phone: 626-696-1400