Provider Demographics
NPI:1124033717
Name:DESERT VIEW FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:DESERT VIEW FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANOOP
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-923-5975
Mailing Address - Street 1:26224 N TATUM BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7500
Mailing Address - Country:US
Mailing Address - Phone:602-923-5975
Mailing Address - Fax:602-923-5943
Practice Address - Street 1:26224 N TATUM BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7500
Practice Address - Country:US
Practice Address - Phone:602-923-5975
Practice Address - Fax:602-923-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID