Provider Demographics
NPI:1710715305
Name:PARADISE VALLEY HEALTH CLINIC LLC
Entity type:Organization
Organization Name:PARADISE VALLEY HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP AND PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HERMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-725-7106
Mailing Address - Street 1:2990 E NORTHERN AVE STE D107
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4840
Mailing Address - Country:US
Mailing Address - Phone:480-725-7106
Mailing Address - Fax:480-903-5166
Practice Address - Street 1:2990 E NORTHERN AVE STE D107
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4840
Practice Address - Country:US
Practice Address - Phone:480-725-7106
Practice Address - Fax:480-903-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty