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3530 S Val Vista Dr Ste A111 Gilbert AZ 85297-7319 | |
| (480) 608-0058 | |
| (951) 266-5759 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 3530 S Val Vista Dr Ste A111, Gilbert, Arizona |
| Authorized Official Name and Position | Wendy Nelson Davis (OWNER) |
| Authorized Official Contact | 4806080058 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3530 S Val Vista Dr Ste A111 Gilbert AZ 85297-7319 Ph: (480) 608-0058 | 3530 S Val Vista Dr Ste A111 Gilbert AZ 85297-7319 Ph: (480) 608-0058 |
| NPI Number | 1710681333 |
|---|---|
| Provider Enumeration Date | 03/28/2023 |
| Last Update Date | 12/04/2024 |
| Medicare PECOS PAC ID | 2062887607 |
|---|---|
| Medicare Enrollment ID | O20230412001459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710681333 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 225XN1300X | Occupational Therapist - Neurorehabilitation | (* (Not Available)) | Secondary |
| Provider Name | James E Davis |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1619144375 PECOS PAC ID: 4789654948 Enrollment ID: I20080801000138 |
| Provider Name | Wendy Nelson Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689387573 PECOS PAC ID: 6406179241 Enrollment ID: I20230412001551 |
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