Healthcare Provider Details

I. General information

NPI: 1700719150
Provider Name (Legal Business Name): FIGUEROA TREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 204
PHOENIX AZ
85032-3356
US

IV. Provider business mailing address

3655 W ANTHEM WAY SUITE A109 PMB 313
ANTHEM AZ
85086-0430
US

V. Phone/Fax

Practice location:
  • Phone: 602-363-6528
  • Fax:
Mailing address:
  • Phone: 623-505-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICENTE FIGUEROA-DIAZ
Title or Position: OWNER
Credential: MD
Phone: 602-363-6528