Provider Demographics
NPI:1023014883
Name:EAST VALLEY PRIMARY CARE PHYSICIANS
Entity Type:Organization
Organization Name:EAST VALLEY PRIMARY CARE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-820-1133
Mailing Address - Street 1:4515 S MCCLINTOCK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7381
Mailing Address - Country:US
Mailing Address - Phone:480-820-1133
Mailing Address - Fax:480-820-9292
Practice Address - Street 1:4515 S MCCLINTOCK DR
Practice Address - Street 2:STE 100
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7381
Practice Address - Country:US
Practice Address - Phone:480-820-1133
Practice Address - Fax:480-820-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18615261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23664Medicare ID - Type Unspecified