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General NPI Number Information
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NPI Number | 1518921550
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Entity Type | Organization
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Legal Business Name | SUN VALLEY FAMILY VATE
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4045 E BELL RD #125
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City | PHOENIX
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State | AZ
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Zip | 85032-2236
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Country | US
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Telephone | 602-493-3677
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Fax | 602-485-5156
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Provider Business Mailing Address
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Address Line | 4045 E BELL RD #125
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City | PHOENIX
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State | AZ
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Zip | 85032-2236
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Country | US
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Telephone | 602-493-3677
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Fax | 602-485-5156
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. KUMAR DAULAT X
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Credential | D.O.
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Telephone | 602-493-3677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2635
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License Number State | AZ
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