Provider Demographics
NPI:1215376660
Name:YANQUEZ, FEDERICO JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:JAVIER
Last Name:YANQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FEDERICO
Other - Middle Name:JAVIER
Other - Last Name:YANQUEZ ARENAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3925 E FORT LOWELL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1053
Mailing Address - Country:US
Mailing Address - Phone:520-229-0085
Mailing Address - Fax:520-229-0086
Practice Address - Street 1:3925 E FORT LOWELL RD STE 105
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1053
Practice Address - Country:US
Practice Address - Phone:520-229-0085
Practice Address - Fax:520-229-0086
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ585552086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ58555OtherARIZONA MEDICAL LICENSE