Basic Information
| Provider Information | |||||||||
| NPI: | 1750460457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANAYA | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANAYA | ||||||||
| OtherFirstName: | CARLOS | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD PC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 81349 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850691349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239311225 | ||||||||
| FaxNumber: | 6239310088 | ||||||||
| Practice Location | |||||||||
| Address1: | 19829 N 27TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239311225 | ||||||||
| FaxNumber: | 6239310088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 21347 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 128456 | 05 | AZ | MEDICAID | 18073012 | 01 | AZ | STATE COMP | OTHER | AZ0343260 | 01 | AZ | AZ BCBS | OTHER |