Healthcare Provider Details

I. General information

NPI: 1376903138
Provider Name (Legal Business Name): ARIZONA LUNG SLEEP AND VALLEY FEVER INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14961 W BELL RD #175
SURPRISE AZ
85374-3200
US

IV. Provider business mailing address

14961 W BELL RD #175
SURPRISE AZ
85374-3200
US

V. Phone/Fax

Practice location:
  • Phone: 623-232-9830
  • Fax: 623-243-6733
Mailing address:
  • Phone: 623-232-9830
  • Fax: 623-243-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP8508
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP8508
License Number StateAZ

VIII. Authorized Official

Name: DR. JUGROOP BRAR
Title or Position: OWNER/DOCTOR
Credential: M.D.
Phone: 623-313-8599