Healthcare Provider Details

I. General information

NPI: 1225714215
Provider Name (Legal Business Name): RICO CHENYEK MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST STE 605
PHOENIX AZ
85006-2850
US

IV. Provider business mailing address

1300 N 12TH ST STE 605
PHOENIX AZ
85006-2850
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-7606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80759
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: