Individual provider Active NPI

Fernando Vazquez, MD

  • Pediatrics Physician
  • Phoenix, AZ
National Provider Identifier
1710049150
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
33587 Issued in AZ
Practice address
6601 West Thomas Road
Phoenix, AZ 85033
Phone
(602) 243-7277
Fax
(623) 247-9742
NPI assigned
Dec 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 33587 AZ Primary

Addresses

Primary practice location

6601 West Thomas Road
Phoenix, AZ 85033

Mailing address

2702 North 3Rd Street
Suite 4020
Phoenix, AZ 85004-4608
Phone (602) 323-3344

Other identifiers 2

IdentifierTypeStateIssuer
920274MedicaidAZ
920274OtherAZAHCCCS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080220000242 AZ Practitioner - Pediatric Medicine 4486738143 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Park Health Center Current Accepting new patients
Mountain Park Health Center CurrentSince May 2, 2022 Accepting new patients
Mountain Park Health Center CurrentSince May 2, 2022 Accepting new patients
Mountain Park Health Center Past Accepting new patients
Mountain Park Health Center - Dental Past Accepting new patients

Locations

140 N Litchfield Rd
Ste 200106
Goodyear, AZ 85338
Phone (623) 936-6795

140 N Litchfield Rd
Ste 106
Goodyear, AZ 85338
Phone (480) 861-6426

635 E Baseline Rd
Phoenix, AZ 85042

6601 W Thomas Rd
Phoenix, AZ 85033

3003 N Central Ave
Ste 1600
Phoenix, AZ 85012
Phone (602) 323-3492

Organizations & group practices 5

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": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1710049150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 NORTH 3RD STREET",
            "address_2": "SUITE 4020",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044608",
            "telephone_number": "602-323-3344",
            "fax_number": "602-323-3496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 WEST THOMAS ROAD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85033",
            "telephone_number": "602-243-7277",
            "fax_number": "623-247-9742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAZQUEZ",
        "first_name": "FERNANDO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "33587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "920274",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "920274",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.