Healthcare Provider Details

I. General information

NPI: 1033889530
Provider Name (Legal Business Name): CANYON SLEEP NEUROLOGY AND WELLNESS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10645 N TATUM BLVD STE 200-128
PHOENIX AZ
85028-3068
US

IV. Provider business mailing address

10645 N TATUM BLVD STE 200-128
PHOENIX AZ
85028-3068
US

V. Phone/Fax

Practice location:
  • Phone: 480-280-0078
  • Fax: 480-573-9698
Mailing address:
  • Phone: 480-280-0078
  • Fax: 480-573-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW MICHAEL TROESTER
Title or Position: PRESIDENT
Credential: DO
Phone: 480-388-1214