Healthcare Provider Details

I. General information

NPI: 1821191008
Provider Name (Legal Business Name): WEST VALLEY EAR NOSE AND THROAT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE D704
PHOENIX AZ
85029-4608
US

IV. Provider business mailing address

3201 W PEORIA AVE STE D704
PHOENIX AZ
85029-4608
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-4844
  • Fax: 602-843-4846
Mailing address:
  • Phone: 602-843-4844
  • Fax: 602-843-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number3597
License Number StateAZ

VIII. Authorized Official

Name: BRIAN S RIZZO
Title or Position: PRESIDENT
Credential: D.O
Phone: 602-843-4844