# EAST VALLEY MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700342110
- **Authorized official:** DR. DEREK P PRUNI DC (MEMBER)
- **Authorized official phone:** (480) 830-2882

## Contact information

- **Practice address:** 5233 E SOUTHERN AVE STE 103, MESA, AZ 85206-3628
- **Practice address phone:** (480) 830-2882
- **Practice address fax:** (480) 830-2881
- **Mailing address:** 5233 E SOUTHERN AVE STE 103, MESA, AZ 85206-3628
- **Mailing address phone:** (480) 830-2882
- **Mailing address fax:** (480) 830-2881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/11/2019
- **Last updated:** 02/11/2019