Provider Demographics
NPI:1861789802
Name:DESERT VALLEY WELLNESS MEDICAL GROUP, PC
Entity type:Organization
Organization Name:DESERT VALLEY WELLNESS MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAVARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-979-9981
Mailing Address - Street 1:7200 W BELL RD
Mailing Address - Street 2:SUITE E-103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8529
Mailing Address - Country:US
Mailing Address - Phone:623-979-9981
Mailing Address - Fax:623-979-9901
Practice Address - Street 1:7200 W BELL RD
Practice Address - Street 2:SUITE E-103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8529
Practice Address - Country:US
Practice Address - Phone:623-979-9981
Practice Address - Fax:623-979-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty