=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881641215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST VALLEY PSYCHIATRIC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 04/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14506 W GRANITE VALLEY DR STE 108
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-214-1141
-----------------------------------------------------
Fax | 623-214-8903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14506 W GRANITE VALLEY DR STE 108
-----------------------------------------------------
City | SUN CITY WEST
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-214-1141
-----------------------------------------------------
Fax | 623-214-8903
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. PAUL RAYMOND BUTZINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 623-214-1141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------