Healthcare Provider Details

I. General information

NPI: 1649643255
Provider Name (Legal Business Name): WEST VALLEY ASSISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 E CHANDLER BLVD STE 111-385
PHOENIX AZ
85048-0303
US

IV. Provider business mailing address

3961 E CHANDLER BLVD STE 111-385
PHOENIX AZ
85048-0303
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2610
  • Fax: 480-545-2673
Mailing address:
  • Phone: 480-545-2610
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name: SUSAN BARRON
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-332-7336