| Organization Name: | MARYVALE FAMILY PRACTICE GROUP INC. |
| NPI Number: | 1831373091 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AVETIS ORDAKIAN (PRESIDENT) |
| Mailing Address: | 4700 N 51st Ave Suite 6 Phoenix |
| State: | AZ US |
| Postal Code: | 850311237 |
| Phone Number: | 6232095555 |
| Fax Number: | 6232471905 |
| NPI Enumeration Date: | 12/24/2007 |
| NPI Last Update Date: | 04/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |