Provider Demographics
NPI:1063689123
Name:EAST VALLEY NATUROPATHIC DOCTORS
Entity Type:Organization
Organization Name:EAST VALLEY NATUROPATHIC DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:NMD
Authorized Official - Phone:480-985-0000
Mailing Address - Street 1:5416 E SOUTHERN AVE
Mailing Address - Street 2:STE.110
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3622
Mailing Address - Country:US
Mailing Address - Phone:480-985-0000
Mailing Address - Fax:480-985-0029
Practice Address - Street 1:5416 E SOUTHERN AVE
Practice Address - Street 2:STE.110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3622
Practice Address - Country:US
Practice Address - Phone:480-985-0000
Practice Address - Fax:480-985-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03766175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty