Organization
CANYON PEDIATRICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BRUBAKER LMSW (CEO)
(480) 507-2199
Entity
Organization
Contact information
Practice address
2451 E BASELINE RD STE 200, GILBERT, AZ 85234-2405
(480) 776-7155
Mailing address
2451 E BASELINE RD STE 130, GILBERT, AZ 85234-2487
(480) 776-7155
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053504
—
AZ
Enumeration date
02/14/2024
Last updated
03/17/2025
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