Healthcare Provider Details

I. General information

NPI: 1336686187
Provider Name (Legal Business Name): VALLEY KIDNEY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 W BASELINE RD
MESA AZ
85210-6041
US

IV. Provider business mailing address

612 W BASELINE RD
MESA AZ
85210-6041
US

V. Phone/Fax

Practice location:
  • Phone: 480-655-7141
  • Fax:
Mailing address:
  • Phone: 480-655-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MANINDER CHATHA
Title or Position: PRESIDENT
Credential: MD
Phone: 602-361-4694