Provider Demographics
NPI:1346912276
Name:WEST VALLEY PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:WEST VALLEY PAIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAWERU
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:602-325-2020
Mailing Address - Street 1:18301 N 79TH AVE STE F170
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6338
Mailing Address - Country:US
Mailing Address - Phone:602-325-2020
Mailing Address - Fax:602-714-7274
Practice Address - Street 1:18301 N 79TH AVE STE F170
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6338
Practice Address - Country:US
Practice Address - Phone:602-325-2020
Practice Address - Fax:602-714-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty