Provider Demographics
NPI:1225054315
Name:ANAYA, JOHN CURTIS (CCP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CURTIS
Last Name:ANAYA
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27588
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-7588
Mailing Address - Country:US
Mailing Address - Phone:480-777-0607
Mailing Address - Fax:480-777-1345
Practice Address - Street 1:2753 E BROADWAY RD
Practice Address - Street 2:#101-454
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-1579
Practice Address - Country:US
Practice Address - Phone:480-659-6964
Practice Address - Fax:480-659-6791
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004086Medicaid