Provider Demographics
NPI:1902147903
Name:VALLEY INJURY SPECIALISTS LLC
Entity type:Organization
Organization Name:VALLEY INJURY SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:623-915-1000
Mailing Address - Street 1:7802 N 43RD AVE
Mailing Address - Street 2:5
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-8111
Mailing Address - Country:US
Mailing Address - Phone:623-915-1000
Mailing Address - Fax:623-934-0224
Practice Address - Street 1:7802 N 43RD AVE
Practice Address - Street 2:5
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-8111
Practice Address - Country:US
Practice Address - Phone:623-915-1000
Practice Address - Fax:623-934-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty