Healthcare Provider Details

I. General information

NPI: 1801816350
Provider Name (Legal Business Name): EAST VALLEY PEDIATRICS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 E BASELINE RD # 120
GILBERT AZ
85234-2727
US

IV. Provider business mailing address

PO BOX 16455
MESA AZ
85211-6455
US

V. Phone/Fax

Practice location:
  • Phone: 480-615-2010
  • Fax: 480-962-0523
Mailing address:
  • Phone: 480-615-2010
  • Fax: 480-962-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE M VONFLUE
Title or Position: CFO
Credential:
Phone: 480-615-2070