Active NPI
Pacita Tee Opulencia, MD
- Pediatrics Physician
- Mesa, AZ
National Provider Identifier
1043254261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 10704
- Practice address
- 59 S Hibbert
Mesa, AZ 85210-1414 - Phone
- (480) 344-6226
- Fax
- (602) 344-6201
- NPI assigned
- Jun 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 10704 | AZ | Primary |
Addresses
Primary practice location
59 S Hibbert
Mesa, AZ 85210-1414
Mailing address
2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 238289 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10704 | AZ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| District Medical Group, Inc | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316044800000",
"number": "1043254261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 E THOMAS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850168034",
"telephone_number": "602-470-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "59 S HIBBERT",
"city": "MESA",
"state": "AZ",
"postal_code": "852101414",
"telephone_number": "480-344-6226",
"fax_number": "602-344-6201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEE OPULENCIA",
"first_name": "PACITA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-16",
"last_updated": "2011-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AZ",
"license": "10704",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "238289",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.