Healthcare Provider Details

I. General information

NPI: 1942874557
Provider Name (Legal Business Name): PARADISE VALLEY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14631 N CAVE CREEK RD STE 101
PHOENIX AZ
85022-4100
US

IV. Provider business mailing address

14631 N CAVE CREEK RD STE 101
PHOENIX AZ
85022-4100
US

V. Phone/Fax

Practice location:
  • Phone: 480-828-0143
  • Fax:
Mailing address:
  • Phone:
  • Fax: 602-429-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LORENA SULEYMANOVA
Title or Position: OWNER
Credential:
Phone: 480-828-0143