Provider Demographics
NPI:1922714385
Name:WEST VALLEY HEALTH EQUITY
Entity Type:Organization
Organization Name:WEST VALLEY HEALTH EQUITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHARD-BUJAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-341-2825
Mailing Address - Street 1:4338 W THOMAS RD
Mailing Address - Street 2:ST 173
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-3878
Mailing Address - Country:US
Mailing Address - Phone:623-400-5881
Mailing Address - Fax:
Practice Address - Street 1:4338 W THOMAS RD
Practice Address - Street 2:ST 173
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3878
Practice Address - Country:US
Practice Address - Phone:623-400-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty