Healthcare Provider Details

I. General information

NPI: 1235432865
Provider Name (Legal Business Name): CANYON HEMATOLOGY ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 E PRESIDIO ST
MESA AZ
85215-1113
US

IV. Provider business mailing address

PO BOX 20490
MESA AZ
85277-0490
US

V. Phone/Fax

Practice location:
  • Phone: 480-985-1093
  • Fax: 480-985-0468
Mailing address:
  • Phone: 480-985-1093
  • Fax: 480-985-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SUDHIR K AGGARWAL
Title or Position: MEMBER
Credential: M.D.
Phone: 602-478-0736