Healthcare Provider Details

I. General information

NPI: 1467207050
Provider Name (Legal Business Name): AZ VALLEY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 N 88TH DR
GLENDALE AZ
85305-2093
US

IV. Provider business mailing address

5802 N 88TH DR
GLENDALE AZ
85305-2093
US

V. Phone/Fax

Practice location:
  • Phone: 480-213-0232
  • Fax: 623-440-7820
Mailing address:
  • Phone: 480-213-0232
  • Fax: 623-440-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANNA E QUINONES
Title or Position: BILLING ADMIN
Credential: RN
Phone: 623-337-1123