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General NPI Number Information
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NPI Number | 1922714385
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Entity Type | Organization
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Legal Business Name | WEST VALLEY HEALTH EQUITY
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 4338 W THOMAS RD ST 173
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City | PHOENIX
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State | AZ
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Zip | 85031-3878
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Country | US
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Telephone | 623-400-5881
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Fax |
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Provider Business Mailing Address
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Address Line | 4338 W THOMAS RD ST 173
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City | PHOENIX
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State | AZ
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Zip | 85031-3878
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Country | US
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Telephone | 623-400-5881
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | HELEN BOUCHARD-BUJAK
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Credential |
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Telephone | 623-341-2825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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