Provider Demographics
NPI:1225893696
Name:DESERT VALLEY PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:DESERT VALLEY PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENARO
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:VALLADOLID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-664-7336
Mailing Address - Street 1:9393 N 90TH ST., SUITE # 102
Mailing Address - Street 2:PMB # 291
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6116 E ARBOR AVE STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6103
Practice Address - Country:US
Practice Address - Phone:480-770-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty