Provider Demographics
NPI:1235274614
Name:EAST VALLEY CENTER FOR PULMONARY & SLEEP DISORDERS
Entity Type:Organization
Organization Name:EAST VALLEY CENTER FOR PULMONARY & SLEEP DISORDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-325-8173
Mailing Address - Street 1:3155 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5519
Mailing Address - Country:US
Mailing Address - Phone:480-325-8173
Mailing Address - Fax:480-325-8179
Practice Address - Street 1:3155 E SOUTHERN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5519
Practice Address - Country:US
Practice Address - Phone:480-325-8173
Practice Address - Fax:480-325-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37173207RC0200X, 207RP1001X
AZ37982207RC0200X, 207RP1001X
AZ31527207RC0200X, 207RP1001X
AZ38218207RC0200X, 207RP1001X
207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1477586022OtherNPI- DR BADAHMAN
AZ1679522874OtherNPI- DR ANTHONY
AZ1184835282OtherNPI-DR CHOUDRHI
AZ342274Medicaid
AZ789539Medicaid
AZ1194713263OtherNPI - DR JAVADPOOR
AZ1427269638OtherNPI- DR KAVATHIA
AZ307822Medicaid
AZZ118807OtherMEDICARE-INDIVIDUAL
AZZ78326Medicare ID - Type UnspecifiedINDIVIDUAL
AZ342274Medicaid
AZ1184835282OtherNPI-DR CHOUDRHI
Z123645Medicare PIN
AZ789539Medicaid