Healthcare Provider Details

I. General information

NPI: 1114965779
Provider Name (Legal Business Name): VALLEY ARTHRITIS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13943 N. 91ST AVE BUILDING I
PEORIA AZ
85381
US

IV. Provider business mailing address

13943 N. 91ST AVE BUILDING I
PEORIA AZ
85381
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-2690
  • Fax: 623-815-2689
Mailing address:
  • Phone: 623-815-2690
  • Fax: 623-815-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number22399
License Number StateAZ

VIII. Authorized Official

Name: DR. RAVI BHALLA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 623-815-2690