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NPI Code Detail

MEDICARE: CRISTINA ROSE ETIENNE P.A.

MEDICARE: CRISTINA ROSE ETIENNE P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant450PR
2363A00000XPhysician Assistant8321AZ

General Provider Information

NPI Number : 1023695525
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRISTINA ROSE ETIENNE P.A.
Provider Business Mailing Address
First Line : 4834 E BROADWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85711-3610
Country : US
Telephone Number : 480-223-9314
Fax Number : 480-923-9155
Provider Business Practice Location Address
First Line : 444 W OSBORN RD STE 200
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-3817
Country : US
Telephone Number : 480-223-9314
Fax Number : 480-923-9155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2021
Last Update Date : 02/07/2025

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Directions to “ CRISTINA ROSE ETIENNE P.A.” Practice Location

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