NPIMap

Organization Active NPI

Lyl Phoenix LLC

  • Surgery Physician
  • Mesa, AZ
National Provider Identifier
1477269405
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
LYL PHOENIX LLC
Practice address
4860 E Baseline Rd Ste 105
Mesa, AZ 85206-4670
Phone
(480) 485-8585
Fax
(480) 302-7818
NPI assigned
Jan 24, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John J Debarros, MD
Title
Provider/Owner
Phone
(480) 485-8585

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

4860 E Baseline Rd Ste 105
Mesa, AZ 85206-4670

Mailing address

PO Box 40640
Mesa, AZ 85274-0640
Phone (888) 978-1565

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1477269405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40640",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852740640",
            "telephone_number": "888-978-1565",
            "fax_number": "801-931-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4860 E BASELINE RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064670",
            "telephone_number": "480-485-8585",
            "fax_number": "480-302-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYL PHOENIX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-24",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "DEBARROS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "480-485-8585",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.