Healthcare Provider Details

I. General information

NPI: 1821782921
Provider Name (Legal Business Name): ALEXANDRA DIAZ-CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA D. CRUZ MD

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3344 N FUTRALL DR
FAYETTEVILLE AR
72703-4057
US

IV. Provider business mailing address

PO BOX 10678
FAYETTEVILLE AR
72703-0046
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8200
  • Fax:
Mailing address:
  • Phone: 479-582-7350
  • Fax: 479-582-7368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE-20518
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: