Provider Demographics
NPI:1679031694
Name:VALLEY MATRIX ANESTHESIA LLC
Entity Type:Organization
Organization Name:VALLEY MATRIX ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-996-0800
Mailing Address - Street 1:9458 E IRONWOOD SQUARE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9458 E IRONWOOD SQUARE DR STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4571
Practice Address - Country:US
Practice Address - Phone:480-579-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center