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NPI Code Detail

MEDICARE: DESERT VALLEY INFECTIOUS DISEASE PHYSICIANS

MEDICARE: DESERT VALLEY INFECTIOUS DISEASE PHYSICIANS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RI0200XInfectious Disease Physician22745AZ

General Provider Information

NPI Number : 1356553986
Entity Type Code : Organization
Provider Name (Legal Business Name) : DESERT VALLEY INFECTIOUS DISEASE PHYSICIANS
Provider Business Mailing Address
First Line : PO BOX 16303
Second Line :
City : PHOENIX
State : AZ
Zip : 85011-6303
Country : US
Telephone Number : 602-230-1215
Fax Number : 602-241-0249
Provider Business Practice Location Address
First Line : 233 W LAMAR RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-1219
Country : US
Telephone Number : 602-369-1941
Fax Number : 602-241-0249
Authorized Official
Title or Position : OWNER
Name : DR. DANIEL R MARINO
Credential : MD
Telephone Number : 602-369-1941
Provider Enumeration Date : 05/04/2007
Last Update Date : 04/17/2014

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Directions to “DESERT VALLEY INFECTIOUS DISEASE PHYSICIANS ” Practice Location

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