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General NPI Number Information
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NPI Number | 1649206301
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Entity Type | Organization
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Legal Business Name | MARYVALE CARDIOLOGY PC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 8410 W THOMAS RD BLDG 2, SUITE 116
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City | PHOENIX
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State | AZ
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Zip | 85037-3329
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Country | US
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Telephone | 623-848-3295
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Fax | 623-848-3019
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Provider Business Mailing Address
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Address Line | 8410 W THOMAS RD BLDG 2, SUITE 116
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City | PHOENIX
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State | AZ
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Zip | 85037-3329
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Country | US
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Telephone | 623-848-3295
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Fax | 623-848-3019
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DEBBIE ANN GONZALES
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Credential | CMA
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Telephone | 623-848-3295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | AZ
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