MEDICARE: MONICA VALDES-DE LA CRUZ MD

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	208000000X	Pediatrics Physician	25854	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588649198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA VALDES-DE LA CRUZ MD

Provider Business Mailing Address
First Line	:	2167 W ORANGE GROVE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3118
Country	:	US
Telephone Number	:	520-544-7650
Fax Number	:	520-544-7628

Provider Business Practice Location Address
First Line	:	2167 W ORANGE GROVE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3118
Country	:	US
Telephone Number	:	520-544-7650
Fax Number	:	520-544-7628

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	01/22/2016

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