Healthcare Provider Details

I. General information

NPI: 1861855462
Provider Name (Legal Business Name): SOUTH VAL VISTA MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S. VAL VISTA DR. #105
GILBERT AZ
85296
US

IV. Provider business mailing address

1450 W GUADALUPE RD #120
GILBERT AZ
85233-3042
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-2900
  • Fax: 480-926-2260
Mailing address:
  • Phone: 480-926-7800
  • Fax: 480-926-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. GREG J VOGEL
Title or Position: OWNER MANAGER
Credential: DC
Phone: 480-497-2900