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Contact Information

CANYON PEDIATRICS, INC
815 E UNIVERSITY DR
MESA, AZ85203-8032
 Phone: 480-776-7155
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Health Maintenance Organization

302R00000X
 

Primary Care

261QP2300X
Indicates primary specialty

NPI Profile & details for CANYON PEDIATRICS, INC

NPI # 1780449348
LBN Legal business name CANYON PEDIATRICS, INC
Authorized official RICHARD BRUBAKER - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 02/13/2024
Last updated 03/17/2025 - More than a year ago
Identifiers
AZ Medicaid 053504
AZ Other 2048349 AETNA HEALTH CARE
AZ Other 6327185 CIGNA US HEALTH CARE
AZ Other 1Z5874 HEALTH NET
AZ Other 183427266 TRICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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