Healthcare Provider Details

I. General information

NPI: 1215684188
Provider Name (Legal Business Name): WEST VALLEY SURGICAL SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14155 N 83RD AVE STE 105
PEORIA AZ
85381-5640
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 623-201-8277
  • Fax:
Mailing address:
  • Phone: 209-956-7732
  • Fax: 209-956-7738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JARVIS WALTERS
Title or Position: OWNER
Credential: DO
Phone: 209-956-7732