Canyon Family Medicine PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CANYON FAMILY MEDICINE PLLC

Practice address

6242 E Arbor Ave Ste 118
Mesa, AZ 85206-1309

Phone

(602) 805-4914

Fax

(602) 805-4917

NPI assigned

Nov 2, 2021

Organization subpart

No

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

Authorized official

Name

Laura Ayn Hafez, NPNPI 1104476019

Title

Founder

Phone

(602) 805-4914

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Canyon Family Medicine Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laura Hafez, FNP

  • Primary Care Nurse Practitioner
  • Mesa, AZ
  • NPI 1104476019
  Medicare reassignment Care Compare group NPD Authorized official
• Michelle D Correa, DNP, FNP-BC

  • Family Nurse Practitioner
  • Scottsdale, AZ
  • NPI 1679240253
  Medicare reassignment Care Compare group NPD
• Jesse Lauren Pack, FNP-C

  • Family Nurse Practitioner
  • Mesa, AZ
  • NPI 1255098075
  Medicare reassignment Care Compare group NPD
• Jennifer Kelly Weltsch, FNP

  • Primary Care Nurse Practitioner
  • Mesa, AZ
  • NPI 1235990904
  Medicare reassignment Care Compare group NPD
• Alexis Dea Snyder, FNP

  • Primary Care Nurse Practitioner
  • Mesa, AZ
  • NPI 1316894678
  Medicare reassignment Care Compare group
• Wendy Nelson Davis, FNP

  • Family Nurse Practitioner
  • Gilbert, AZ
  • NPI 1689387573
  Medicare reassignment NPD
• Courtney Dechesaro, DNP, FNP-C

  • Acute Care Nurse Practitioner
  • Phoenix, AZ
  • NPI 1770288276
  Medicare reassignment NPD
• Boriana Rousseva Nikolova, FNP-BC

  • Family Nurse Practitioner
  • Ajo, AZ
  • NPI 1598432585
  Medicare reassignment NPD

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

{
    "created_epoch": "1635811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741564800000",
    "number": "1780349902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6242 E ARBOR AVE STE 118",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061309",
            "telephone_number": "602-805-4914",
            "fax_number": "602-805-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6242 E ARBOR AVE STE 118",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061309",
            "telephone_number": "602-805-4914",
            "fax_number": "602-805-4917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-02",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A",
        "authorized_official_last_name": "HAFEZ",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "AYN",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "602-805-4914",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104341",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Kareo",
            "affiliation": "N",
            "endpointDescription": "Kareo",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6242 E Arbor Ave Ste 118",
            "city": "Mesa",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "852061309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Canyon Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Canyon Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Megan Elnora Cannell, PHARM.D.
• Uneeka Canty, PHLEBOTOMIST
• Canuhearwell
• Paul Canup
• Caryssa Canuto
• Canyon Hematology Oncology
• Canyon Lakes Dental Group and Orthodontics, LLP
• Canyon Pain and Spine
• Canyon Pain and Spine
• Canyon Pain and Spine

• Family Medicine Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.