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General NPI Number Information
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NPI Number | 1063021269
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Entity Type | Organization
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Legal Business Name | VALLEY DIRECT PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 13970 W WOODBRIDGE AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-1485
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Country | US
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Telephone | 646-352-2619
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Fax |
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Provider Business Mailing Address
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Address Line | 13970 W WOODBRIDGE AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-1485
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Country | US
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Telephone | 646-352-2619
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARUN BASSI
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Credential |
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Telephone | 623-562-0130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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