Provider Demographics
NPI:1992351860
Name:ADVANCED MICROSURGERY CENTERS OF THE VALLEY
Entity type:Organization
Organization Name:ADVANCED MICROSURGERY CENTERS OF THE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-444-7491
Mailing Address - Street 1:10255 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3822
Mailing Address - Country:US
Mailing Address - Phone:480-444-7491
Mailing Address - Fax:
Practice Address - Street 1:10255 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3822
Practice Address - Country:US
Practice Address - Phone:480-444-7491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical