=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619800067
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIGUEROA TREE LIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16601 N 40TH ST STE 204
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85032-3356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-505-9880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3655 W ANTHEM WAY SUITE A109 PMB 313
-----------------------------------------------------
City | ANTHEM
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85086-0430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VICENTE FIGUEROA-DIAZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 602-363-6528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------