MEDICARE: MESA OBSTETRICIANS & GYNECOLOGISTS, LTD

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	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F00471	OTHER	AZ	PHX HEALTH PLAN
2	ZWCHVZ	OTHER	AZ	PTAN

General Provider Information

NPI Number	:	1538202486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA OBSTETRICIANS & GYNECOLOGISTS, LTD

Provider Business Mailing Address
First Line	:	PO BOX 1377
Second Line	:
City	:	HIGLEY
State	:	AZ
Zip	:	85236-1377
Country	:	US
Telephone Number	:	602-816-5544
Fax Number	:	602-626-8681

Provider Business Practice Location Address
First Line	:	801 S POWER RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-5222
Country	:	US
Telephone Number	:	602-816-5544
Fax Number	:	602-626-8681

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERNESTO MORALES GOMEZ
Credential	:
Telephone Number	:	602-369-5446

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	12/17/2025

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