MEDICARE: DAISY CRUZ RD

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
1	133VN1005X	Renal Nutrition Registered Dietitian	86117917	AZ
2	133V00000X	Registered Dietitian	86117917	AZ

General Provider Information

NPI Number	:	1558029330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY CRUZ RD

Provider Business Mailing Address
First Line	:	3421 N 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3421 N 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-3635
Country	:	US
Telephone Number	:	800-881-5101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	05/26/2025

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Directions to “ DAISY CRUZ RD” Practice Location

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