Healthcare Provider Details

I. General information

NPI: 1346428927
Provider Name (Legal Business Name): VALLEY NEUROLOGY CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10752 N 89TH PL STE B214
SCOTTSDALE AZ
85260-6251
US

IV. Provider business mailing address

10752 N 89TH PL STE B214
SCOTTSDALE AZ
85260-6251
US

V. Phone/Fax

Practice location:
  • Phone: 480-391-8222
  • Fax: 480-614-8225
Mailing address:
  • Phone: 480-391-8222
  • Fax: 480-614-8225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number30513
License Number StateAZ

VIII. Authorized Official

Name: DR. ALIREZA AHMADIEH
Title or Position: OWNER
Credential: MD
Phone: 480-391-8222