Healthcare Provider Details

I. General information

NPI: 1720159841
Provider Name (Legal Business Name): ARIZONA VISTA FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N GREENFIELD RD # 101
GILBERT AZ
85234-5044
US

IV. Provider business mailing address

875 N GREENFIELD RD # 101
GILBERT AZ
85234-5044
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-1212
  • Fax: 480-892-4941
Mailing address:
  • Phone: 480-892-1212
  • Fax: 480-892-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26887
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3160
License Number StateAZ

VIII. Authorized Official

Name: DR. TERESA LANIER
Title or Position: PRESIDENT OF AVFM
Credential: MD., PHD.
Phone: 480-892-1212