Healthcare Provider Details

I. General information

NPI: 1336060755
Provider Name (Legal Business Name): VALLEY SURGICAL CARDIO-THORACIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W COOL DR STE 103
TUCSON AZ
85704-6551
US

IV. Provider business mailing address

4022 E GREENWAY RD STE 11-191
PHOENIX AZ
85032-4797
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-9790
  • Fax: 602-953-5466
Mailing address:
  • Phone: 602-996-4747
  • Fax: 602-953-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICIA J MANGRAM
Title or Position: CEO
Credential: MD
Phone: 602-996-4747