Provider Demographics
NPI:1194893800
Name:DVMA, LLC
Entity type:Organization
Organization Name:DVMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PERMINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANGHERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-974-1500
Mailing Address - Street 1:13350 N 94TH DR
Mailing Address - Street 2:SUITE A101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-974-1500
Mailing Address - Fax:623-933-3383
Practice Address - Street 1:13350 N 94TH DR
Practice Address - Street 2:SUITE A101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-974-1500
Practice Address - Fax:623-933-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTIN NUMBER