Provider Demographics
NPI:1689898611
Name:FIGUEROA-DIAZ, VICENTE (MD, PA-C)
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:FIGUEROA-DIAZ
Suffix:
Gender:M
Credentials:MD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 W ANTHEM WAY
Mailing Address - Street 2:SUITE A-109; PMB 313
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0430
Mailing Address - Country:US
Mailing Address - Phone:623-505-4479
Mailing Address - Fax:623-505-9880
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-505-4479
Practice Address - Fax:623-505-9880
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15058363AM0700X
AZ43505208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA150581Medicare ID - Type UnspecifiedPROVIDER#
CAP07672Medicare UPIN