Healthcare Provider Details

I. General information

NPI: 1821728916
Provider Name (Legal Business Name): HERA HEALTH MEDICAL GROUP - AZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36375 N GANTZEL RD STE 103
SAN TAN VALLEY AZ
85140-7334
US

IV. Provider business mailing address

36375 N GANTZEL RD STE 103
SAN TAN VALLEY AZ
85140-7334
US

V. Phone/Fax

Practice location:
  • Phone: 480-987-5500
  • Fax: 480-987-5017
Mailing address:
  • Phone: 480-987-5500
  • Fax: 480-987-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIAN IRIYE
Title or Position: AUTH OFFICIAL
Credential: MD
Phone: 480-987-5500