Provider Demographics
NPI:1013359165
Name:WEST VALLEY PAIN SOLUTIONS, LLC
Entity Type:Organization
Organization Name:WEST VALLEY PAIN SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVER
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:PENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-628-0486
Mailing Address - Street 1:9140 W THOMAS RD
Mailing Address - Street 2:SUITE B-106
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3378
Mailing Address - Country:US
Mailing Address - Phone:623-939-1375
Mailing Address - Fax:623-388-6880
Practice Address - Street 1:9140 W THOMAS RD
Practice Address - Street 2:SUITE B-106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3378
Practice Address - Country:US
Practice Address - Phone:623-939-1375
Practice Address - Fax:623-388-6880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain