Healthcare Provider Details

I. General information

NPI: 1407492069
Provider Name (Legal Business Name): CANYON MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 W CORDIA LN
PHOENIX AZ
85083-7404
US

IV. Provider business mailing address

6610 W CORDIA LN
PHOENIX AZ
85083-7404
US

V. Phone/Fax

Practice location:
  • Phone: 623-888-9033
  • Fax: 623-572-9405
Mailing address:
  • Phone: 623-888-9033
  • Fax: 623-572-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARY ARIAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 623-824-3660