Healthcare Provider Details

I. General information

NPI: 1477012375
Provider Name (Legal Business Name): CATHERINE CECELIA VATSIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 N 3RD ST
PHOENIX AZ
85004-1102
US

IV. Provider business mailing address

2610 N 3RD ST
PHOENIX AZ
85004-1102
US

V. Phone/Fax

Practice location:
  • Phone: 480-610-6100
  • Fax:
Mailing address:
  • Phone: 480-610-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number77079
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: