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
815 E UNIVERSITY DR, MESA, AZ 85203-8032
(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
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053504
—
AZ
01
—
183427266
TRICARE
AZ
01
—
1Z5874
HEALTH NET
AZ
01
—
2048349
AETNA HEALTH CARE
AZ
01
—
6327185
CIGNA US HEALTH CARE
AZ
Enumeration date
02/13/2024
Last updated
03/17/2025
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