Provider Demographics
NPI:1629682190
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:DR
Authorized Official - First Name:GENARO
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:VALLADOLID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-770-5015
Mailing Address - Street 1:9393 N 90TH ST STE 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:480-770-5015
Mailing Address - Fax:480-691-2450
Practice Address - Street 1:18325 N ALLIED WAY STE 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3107
Practice Address - Country:US
Practice Address - Phone:480-770-5015
Practice Address - Fax:480-691-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty