Provider Demographics
NPI:1407565906
Name:ARVIZO, JESUS RYAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:RYAN
Last Name:ARVIZO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1506
Mailing Address - Country:US
Mailing Address - Phone:623-344-6800
Mailing Address - Fax:
Practice Address - Street 1:950 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1506
Practice Address - Country:US
Practice Address - Phone:623-344-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241088363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty