Canyon Pediatrics, Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

CANYON PEDIATRICS, INC

Practice address

815 E University Dr
Mesa, AZ 85203-8032

Phone

(480) 776-7155

NPI assigned

Feb 13, 2024

Organization subpart

No

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

Authorized official

Name

Richard Brubaker, LMSW

Title

Ceo

Phone

(480) 507-2199

Specialties & licenses 3

Addresses

Other identifiers 5

Tax ID family

Canyon Pediatrics4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Canyon Pediatrics, Inc

  • Pediatrics Physician
  • Gilbert, AZ
  • NPI 1053176677
  NPD tax ID
• Canyon Pediatrics, Inc

  • Primary Care Clinic/Center
  • Gilbert, AZ
  • NPI 1831185362
  NPD tax ID
• Canyon Pediatrics, Inc

  • Primary Care Clinic/Center
  • Gilbert, AZ
  • NPI 1861257420
  NPD tax ID

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1780449348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 E BASELINE RD STE 130",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342487",
            "telephone_number": "480-776-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 E UNIVERSITY DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852038032",
            "telephone_number": "480-776-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON PEDIATRICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-13",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "BRUBAKER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-507-2199",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "1Z5874",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "183427266",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA US HEALTH CARE",
            "identifier": "6327185",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTH CARE",
            "identifier": "2048349",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053504",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Canyon Pain and Spine
• Canyon Pain and Spine
• Canyon Pain and Spine
• Canyon Pain Surgery Center
• Canyon Pain Surgery Center
• Canyon Taxi L.L.C.
• Canyonbehavior Health
• Lienhoan Cao
• Capable Therapy
• Cape Behavioral Health

• Pediatrics Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; 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.