Provider Demographics
NPI:1407565906
Name:ARVIZO, JESUS RYAN JR (FNP-C)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:RYAN
Last Name:ARVIZO
Suffix:JR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12317 W LARKSPUR RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-5286
Mailing Address - Country:US
Mailing Address - Phone:623-296-6682
Mailing Address - Fax:
Practice Address - Street 1:239 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1249
Practice Address - Country:US
Practice Address - Phone:480-549-8865
Practice Address - Fax:520-391-2936
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241088163WW0000X, 363L00000X, 363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty