Provider Demographics
NPI:1770659120
Name:WEST VALLEY ENDOCRINOLOGY LLC
Entity Type:Organization
Organization Name:WEST VALLEY ENDOCRINOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAYANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPPIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-825-4845
Mailing Address - Street 1:9650 W BAJADA RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2904
Mailing Address - Country:US
Mailing Address - Phone:623-825-4845
Mailing Address - Fax:
Practice Address - Street 1:9150 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 118
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2384
Practice Address - Country:US
Practice Address - Phone:623-825-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty