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General NPI Number Information
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NPI Number | 1841439932
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Entity Type | Organization
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Legal Business Name | DESERT VALLEY WELLNESS
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 5310 W THUNDERBIRD RD SUITE 203
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City | GLENDALE
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State | AZ
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Zip | 85306-4706
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Country | US
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Telephone | 602-548-6500
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Fax | 602-993-0054
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Provider Business Mailing Address
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Address Line | 5310 W THUNDERBIRD RD SUITE 203
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City | GLENDALE
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State | AZ
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Zip | 85306-4706
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Country | US
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Telephone | 602-548-6500
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Fax | 602-993-0054
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Authorized Official
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Title or Position | MEMBER
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Name | DEBI ROBERTSON
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Credential |
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Telephone | 602-548-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3259
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License Number State | AZ
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