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General NPI Number Information
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NPI Number | 1487193371
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Entity Type | Organization
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Legal Business Name | EAST VALLEY UROLOGY CENTER PLC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 6116 E ARBOR AVE
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City | MESA
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State | AZ
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Zip | 85206-6107
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Country | US
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Telephone | 480-219-1010
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Fax | 480-219-1771
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Provider Business Mailing Address
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Address Line | 6116 E ARBOR AVE
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City | MESA
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State | AZ
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Zip | 85206-6107
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Country | US
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Telephone | 480-219-1010
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Fax | 480-219-1771
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | RAHUL D MEHAN
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Credential | M.D.
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Telephone | 480-409-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 45544
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License Number State | AZ
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