Provider Demographics
NPI:1124298468
Name:EAST VALLEY ALLERGY & ASTHMA CENTER, INC.
Entity type:Organization
Organization Name:EAST VALLEY ALLERGY & ASTHMA CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAPUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-855-9119
Mailing Address - Street 1:3491 S MERCY RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0433
Mailing Address - Country:US
Mailing Address - Phone:480-855-9119
Mailing Address - Fax:480-855-9120
Practice Address - Street 1:3491 S MERCY RD
Practice Address - Street 2:SUITE #101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0433
Practice Address - Country:US
Practice Address - Phone:480-855-9119
Practice Address - Fax:480-855-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29731207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG88465Medicare UPIN
AZ77735Medicare PIN