Healthcare Provider Details

I. General information

NPI: 1669994539
Provider Name (Legal Business Name): VALLEY WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E BELL RD STE 112
PHOENIX AZ
85022
US

IV. Provider business mailing address

702 E BELL RD STE 103
PHOENIX AZ
85022-6648
US

V. Phone/Fax

Practice location:
  • Phone: 602-603-2882
  • Fax: 602-603-2283
Mailing address:
  • Phone: 602-603-2282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN LOUIS SPIEGEL JR.
Title or Position: OWNER
Credential:
Phone: 510-435-2164