Healthcare Provider Details

I. General information

NPI: 1003303900
Provider Name (Legal Business Name): KENNETH VEIGA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18701 N 67TH AVE
GLENDALE AZ
85308-7100
US

IV. Provider business mailing address

530 E MCDOWELL RD # 107-402
PHOENIX AZ
85004-1549
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-1000
  • Fax:
Mailing address:
  • Phone: 925-817-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number008852
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number008852
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number008852
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: