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General NPI Number Information
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NPI Number | 1861170078
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Entity Type | Organization
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Legal Business Name | VALLEY CARE CLINIC PLLC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 09/10/2023
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Provider Practice Location Address
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Address Line | 1845 E BROADWAY RD STE 116
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City | TEMPE
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State | AZ
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Zip | 85282-1685
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Country | US
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Telephone | 480-499-0102
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 E BROADWAY RD STE 116
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City | TEMPE
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State | AZ
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Zip | 85282-1685
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Country | US
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Telephone | 480-499-0102
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. ALLAN CAGAMPAN BUENAVENTURA
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Credential | FNP-BC
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Telephone | 480-410-9739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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