Healthcare Provider Details

I. General information

NPI: 1306315445
Provider Name (Legal Business Name): EAST VALLEY HEART RHYTHM CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S VAL VISTA DR STE 187 SIUTE 187
GILBERT AZ
85295-1674
US

IV. Provider business mailing address

PO BOX 1749
CHANDLER AZ
85244-1749
US

V. Phone/Fax

Practice location:
  • Phone: 602-319-3334
  • Fax:
Mailing address:
  • Phone: 602-319-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHADI IDRIS
Title or Position: OWNER
Credential: MD
Phone: 602-319-3334