Provider Demographics
NPI:1821283342
Name:DESERT VISTA NEUROPSYCHOLOGICAL SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:DESERT VISTA NEUROPSYCHOLOGICAL SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:III
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-688-9635
Mailing Address - Street 1:7227 N 16TH ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5251
Mailing Address - Country:US
Mailing Address - Phone:602-216-6900
Mailing Address - Fax:602-371-9889
Practice Address - Street 1:7227 N 16TH ST
Practice Address - Street 2:SUITE 219
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5251
Practice Address - Country:US
Practice Address - Phone:602-216-6900
Practice Address - Fax:602-371-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3593103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty