MEDICARE: VANESSA BREGUEZ MITCHELL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	6423	AZ
2	363A00000X	Physician Assistant	6423	AZ

General Provider Information

NPI Number	:	1326597444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA BREGUEZ MITCHELL PA

Provider Business Mailing Address
First Line	:	1760 E PECOS RD STE 235
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-3207
Country	:	US
Telephone Number	:	480-813-0944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 E PECOS RD STE 207
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-3202
Country	:	US
Telephone Number	:	480-813-0944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2016
Last Update Date	:	10/02/2023

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