Provider Demographics
NPI:1851561138
Name:DESERT VALLEY NEUROLOGY, LLC
Entity Type:Organization
Organization Name:DESERT VALLEY NEUROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERPHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-855-6292
Mailing Address - Street 1:PO BOX 52500
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0125
Mailing Address - Country:US
Mailing Address - Phone:480-855-6292
Mailing Address - Fax:480-855-6393
Practice Address - Street 1:920 E WILLIAMS FIELD RD
Practice Address - Street 2:STE 102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4880
Practice Address - Country:US
Practice Address - Phone:480-855-6292
Practice Address - Fax:480-855-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ341342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ121345Medicare PIN