1023182227 NPI number — DR. CHRISTIAN COSCA CRUZ MD

Table of content: DR. CHRISTIAN COSCA CRUZ MD (NPI 1023182227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023182227 NPI number — DR. CHRISTIAN COSCA CRUZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
CHRISTIAN
Provider Middle Name:
COSCA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023182227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2149 E WARNER RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85284-3495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-393-0309
Provider Business Mailing Address Fax Number:
480-610-6189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1498 SOUTHGATE AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
DALY CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94015-4015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-755-4490
Provider Business Practice Location Address Fax Number:
650-755-2920
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  A96754 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1316099658 . This is a "GROUP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1336117829 . This is a "WEST BAY NEPHROLOGY ASSOCIATES'S NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ27071Z . This is a "GROUP CA MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ86010Z . This is a "WEST BAY NEPHROLOGY ASSOCIATES'S TAX ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023182227 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ04539Z . This is a "MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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