MEDICARE: KAREN MARIE VAZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080S0010X	Pediatric Sports Medicine Physician	73061	AZ

General Provider Information

NPI Number	:	1144800368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MARIE VAZ MD

Provider Business Mailing Address
First Line	:	2108 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7761
Country	:	US
Telephone Number	:	602-933-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7710
Country	:	US
Telephone Number	:	602-933-0945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2021
Last Update Date	:	04/23/2025

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