Provider Demographics
NPI:1356553986
Name:DESERT VALLEY INFECTIOUS DISEASE PHYSICIANS
Entity type:Organization
Organization Name:DESERT VALLEY INFECTIOUS DISEASE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-369-1941
Mailing Address - Street 1:PO BOX 16303
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-6303
Mailing Address - Country:US
Mailing Address - Phone:602-230-1215
Mailing Address - Fax:602-241-0249
Practice Address - Street 1:233 W LAMAR RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1219
Practice Address - Country:US
Practice Address - Phone:602-369-1941
Practice Address - Fax:602-241-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22745207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA37411Medicare UPIN