Healthcare Provider Details

I. General information

NPI: 1477674257
Provider Name (Legal Business Name): EAST VALLEY ENDOCRINOLOGY, DIABETES & METABOLISM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 N. 91ST STREET B-220
SCOTTSDALE AZ
85258
US

IV. Provider business mailing address

9500 E. IRONWOOD SQUARE DRIVE SUITE 201
SCOTTSDALE AZ
85258
US

V. Phone/Fax

Practice location:
  • Phone: 480-323-4800
  • Fax: 480-323-4949
Mailing address:
  • Phone: 480-664-8988
  • Fax: 480-664-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: PENNY D VENUTI
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-664-8988