Pueblo Radiology, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

PUEBLO RADIOLOGY, LLC

Doing business as

Canyon Medical Imaging

Practice address

5501 N 19TH Ave
Suite 111
Phoenix, AZ 85015-2450

Phone

(602) 973-9800

Fax

(602) 973-9933

NPI assigned

Apr 12, 2010

Organization subpart

Yes

Parent organization

WESTERN ARIZONA RADIOLOGYAs reported in NPPES

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

Authorized official

Name

Mr. Daniel Alan Derhaag

Title

Manager

Phone

(602) 973-9800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Canyon Medical Imaging Doing business as

Tax ID family

Canyon Medical Imaging2 organizations share this tax ID, including this one

Part of

Western Arizona Radiology PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pueblo Radiology LLC

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Tucson, AZ
  • NPI 1295061422
  NPD tax ID

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

{
    "created_epoch": "1271030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271030400000",
    "number": "1699091934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852521810",
            "telephone_number": "602-973-9800",
            "fax_number": "602-973-9933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 N 19TH AVE",
            "address_2": "SUITE 111",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850152450",
            "telephone_number": "602-973-9800",
            "fax_number": "602-973-9933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO RADIOLOGY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN ARIZONA RADIOLOGY",
        "enumeration_date": "2010-04-12",
        "last_updated": "2010-04-12",
        "status": "A",
        "authorized_official_last_name": "DERHAAG",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "602-973-9800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "863979",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Medical Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrew Pucci
• Elizabeth Puckerin
• Harsha Choudary Pudhota
• Perla Eduwiges Puebla, NP
• Pueblo Family Physicians LTD
• Lysbeth Puente
• Marcos C. Puente, PHARMD
• Sarah Elizabeth Puente, DC
• Synthia Puffenberger, PH.D.
• Eric Gilbert Puga, MS CCC-SLP

• Radiology Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Radiology Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; 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.