1871887828 NPI number — EAST VALLEY DIABETES & ENDOCRINOLOGY PLC

Table of content: (NPI 1871887828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871887828 NPI number — EAST VALLEY DIABETES & ENDOCRINOLOGY PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST VALLEY DIABETES & ENDOCRINOLOGY PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1871887828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 S LINDSAY RD
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85297-1506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-782-9531
Provider Business Mailing Address Fax Number:
480-782-9530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 S LINDSAY RD
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85297-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-782-9531
Provider Business Practice Location Address Fax Number:
480-782-9530
Provider Enumeration Date:
06/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WADWEKAR
Authorized Official First Name:
DEVENDRA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
480-782-9531

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  44679 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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