Provider Demographics
NPI:1245379288
Name:HUARCAYA, ERICK (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:HUARCAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W BASELINE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1068
Mailing Address - Country:US
Mailing Address - Phone:602-323-0904
Mailing Address - Fax:602-812-3559
Practice Address - Street 1:2727 W BASELINE RD STE 8
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1068
Practice Address - Country:US
Practice Address - Phone:602-323-0904
Practice Address - Fax:602-812-3559
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51183207Q00000X
LAMD 202744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1460117Medicaid
LA4N941DJ03Medicare PIN
LA4N941Medicare PIN
LA4N941CY49Medicare PIN