Provider Demographics
NPI:1598743478
Name:SARMIENTO, JOHN GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GABRIEL
Last Name:SARMIENTO
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 1:28471 N VISTANCIA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2092
Mailing Address - Country:US
Mailing Address - Phone:623-327-8800
Mailing Address - Fax:
Practice Address - Street 1:28471 N VISTANCIA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383
Practice Address - Country:US
Practice Address - Phone:623-327-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34147208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ960577Medicaid
AZ960577Medicaid