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Organization
WEST VALLEY PAIN SPECIALISTS, LLC
Active
Organization
WEST VALLEY PAIN SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONY WAWERU CRNA (OWNER)
(602) 325-2020
Entity
Organization
Contact information
Practice address
18301 N 79TH AVE STE F170, GLENDALE, AZ 85308-6338
(602) 325-2020
(602) 714-7274
Mailing address
18301 N 79TH AVE STE F170, GLENDALE, AZ 85308-6338
(602) 325-2020
(602) 714-7274
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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