1992226948 NPI number — SOLTERRA DEER VALLEY OPERATIONS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992226948 NPI number — SOLTERRA DEER VALLEY OPERATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLTERRA DEER VALLEY OPERATIONS, LLC
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:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992226948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14650 N 78TH WAY STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-2970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
16025443195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2641 W UNION HILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85027-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-603-7480
Provider Business Practice Location Address Fax Number:
602-603-7485
Provider Enumeration Date:
06/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DURAN
Authorized Official First Name:
INGE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
480-621-4609

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL10387 , 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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