Basic Information
| Provider Information | |||||||||
| NPI: | 1801816350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST VALLEY PEDIATRICS, PLC | ||||||||
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| OtherOrganizationName: | FIRST CHOICE OBSTETRICS & GYNECOLOGY, PLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16455 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852116455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806152010 | ||||||||
| FaxNumber: | 4809620523 | ||||||||
| Practice Location | |||||||||
| Address1: | 3921 E BASELINE RD # 120 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852342727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806152010 | ||||||||
| FaxNumber: | 4809620523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VONFLUE | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4806152070 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.