# CANYON FAMILY MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Canyon Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780349902
- **Authorized official:** LAURA AYN HAFEZ NP (FOUNDER)
- **Authorized official phone:** (602) 805-4914

## Contact information

- **Practice address:** 6242 E ARBOR AVE STE 118, MESA, AZ 85206-1309
- **Practice address phone:** (602) 805-4914
- **Practice address fax:** (602) 805-4917
- **Mailing address:** 6242 E ARBOR AVE STE 118, MESA, AZ 85206-1309
- **Mailing address phone:** (602) 805-4914
- **Mailing address fax:** (602) 805-4917

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/02/2021
- **Last updated:** 03/10/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 104341 | — | AZ |