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General NPI Number Information
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NPI Number | 1134473838
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Entity Type | Organization
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Legal Business Name | EAST VALLEY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 10238 E HAMPTON AVE SUITE 212
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City | MESA
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State | AZ
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Zip | 85209-3316
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Country | US
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Telephone | 480-632-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 10238 E HAMPTON AVE SUITE 212
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City | MESA
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State | AZ
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Zip | 85209-3316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF HEALTHCARE ADMINISTRATOR
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Name | MR. RICHARD A. WEST
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Credential |
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Telephone | 480-845-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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