Healthcare Provider Details

I. General information

NPI: 1659080067
Provider Name (Legal Business Name): GEOFFREY FIGUERAS MEDIDA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6739 W CACTUS RD
PEORIA AZ
85381-5311
US

IV. Provider business mailing address

6739 W CACTUS RD
PEORIA AZ
85381-5311
US

V. Phone/Fax

Practice location:
  • Phone: 833-242-0100
  • Fax: 855-420-6361
Mailing address:
  • Phone: 833-242-0100
  • Fax: 855-420-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number283264
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: