Healthcare Provider Details

I. General information

NPI: 1922714385
Provider Name (Legal Business Name): WEST VALLEY HEALTH EQUITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 W THOMAS RD ST 173
PHOENIX AZ
85031-3878
US

IV. Provider business mailing address

4338 W THOMAS RD ST 173
PHOENIX AZ
85031-3878
US

V. Phone/Fax

Practice location:
  • Phone: 623-400-5881
  • Fax:
Mailing address:
  • Phone: 623-400-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HELEN BOUCHARD-BUJAK
Title or Position: DIRECTOR
Credential:
Phone: 623-341-2825