Provider Demographics
NPI:1992563175
Name:VALLEY BARIATRIC PLLC
Entity type:Organization
Organization Name:VALLEY BARIATRIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-794-5734
Mailing Address - Street 1:726 N GREENFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5062
Mailing Address - Country:US
Mailing Address - Phone:602-603-2458
Mailing Address - Fax:210-695-7714
Practice Address - Street 1:726 N GREENFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5062
Practice Address - Country:US
Practice Address - Phone:602-603-2458
Practice Address - Fax:602-603-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center