Healthcare Provider Details

I. General information

NPI: 1710106232
Provider Name (Legal Business Name): WEST VALLEY WOMENS CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD 155
PHOENIX AZ
85037-3328
US

IV. Provider business mailing address

9305 W THOMAS RD 155
PHOENIX AZ
85037-3328
US

V. Phone/Fax

Practice location:
  • Phone: 623-936-1780
  • Fax: 623-936-9116
Mailing address:
  • Phone: 623-936-1780
  • Fax: 623-936-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MYSTIE JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 623-936-1780