Healthcare Provider Details

I. General information

NPI: 1477751683
Provider Name (Legal Business Name): VALLEY ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 S VAL VISTA DR SUITE 126
GILBERT AZ
85295
US

IV. Provider business mailing address

2563 S VAL VISTA DR SUITE 126
GILBERT AZ
85295
US

V. Phone/Fax

Practice location:
  • Phone: 480-733-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANJAY M AHLUWALIA
Title or Position: OWNER
Credential: MD
Phone: 480-733-0500