Healthcare Provider Details

I. General information

NPI: 1558719955
Provider Name (Legal Business Name): SONJA JEAN WILSON CRUZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W APACHE TRL
APACHE JUNCTION AZ
85120-3958
US

IV. Provider business mailing address

725 W APACHE TRL
APACHE JUNCTION AZ
85120-3958
US

V. Phone/Fax

Practice location:
  • Phone: 480-870-7130
  • Fax: 480-906-2171
Mailing address:
  • Phone: 480-870-7130
  • Fax: 480-906-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number007998
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: