Provider Demographics
NPI:1851093652
Name:VALLEY PLASTIC SURGERY PLLC
Entity type:Organization
Organization Name:VALLEY PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANNIEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-376-8638
Mailing Address - Street 1:PO BOX 94765
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85070-4765
Mailing Address - Country:US
Mailing Address - Phone:602-376-8638
Mailing Address - Fax:
Practice Address - Street 1:1121 S GILBERT RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5235
Practice Address - Country:US
Practice Address - Phone:602-786-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty