Provider Demographics
NPI:1770740243
Name:DESERT WEST FAMILY HEALTH CENTER, P.C.
Entity type:Organization
Organization Name:DESERT WEST FAMILY HEALTH CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:R
Authorized Official - Last Name:VALDIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-936-7960
Mailing Address - Street 1:9550 W VAN BUREN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-2826
Mailing Address - Country:US
Mailing Address - Phone:623-936-7960
Mailing Address - Fax:623-936-7980
Practice Address - Street 1:9550 W VAN BUREN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-2826
Practice Address - Country:US
Practice Address - Phone:623-936-7960
Practice Address - Fax:623-936-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22654261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ23949Medicare PIN