Provider Demographics
NPI:1477674257
Name:EAST VALLEY ENDOCRINOLOGY, DIABETES & METABOLISM, PC
Entity Type:Organization
Organization Name:EAST VALLEY ENDOCRINOLOGY, DIABETES & METABOLISM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VENUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-664-8988
Mailing Address - Street 1:9500 E. IRONWOOD SQUARE DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-664-8988
Mailing Address - Fax:480-664-8998
Practice Address - Street 1:9700 N. 91ST STREET
Practice Address - Street 2:B-220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-323-4800
Practice Address - Fax:480-323-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ83340Medicare PIN