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General NPI Number Information
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NPI Number | 1992240857
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Entity Type | Organization
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Legal Business Name | EAST VALLEY PSYCHIATRY LLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 1301 S CRISMON RD
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City | MESA
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State | AZ
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Zip | 85209-3767
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Country | US
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Telephone | 623-308-2472
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 N GILBERT RD # 2-134
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City | MESA
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State | AZ
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Zip | 85203-2139
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Country | US
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Telephone | 623-308-2472
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL MERRILL
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Credential | MD
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Telephone | 623-308-2472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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