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General NPI Number Information
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NPI Number | 1982795092
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Entity Type | Organization
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Legal Business Name | DESERT VALLEY PRIMARY CARE PHYSICIANS
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4527 N 27TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-3702
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Country | US
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Telephone | 602-249-4508
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Fax | 602-249-1614
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Provider Business Mailing Address
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Address Line | 4527 N 27TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85017-3702
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Country | US
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Telephone | 602-249-4508
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Fax | 602-249-1614
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRICIA KAY CROAKE-ULEMAN
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Credential | M.D.
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Telephone | 602-249-4805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35485
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License Number State | AZ
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