Healthcare Provider Details

I. General information

NPI: 1669079109
Provider Name (Legal Business Name): ELIZABETH YUSHUVA RPAC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23220 N 71ST DR
GLENDALE AZ
85310-5872
US

IV. Provider business mailing address

23220 N 71ST DR
GLENDALE AZ
85310-5872
US

V. Phone/Fax

Practice location:
  • Phone: 718-737-6972
  • Fax:
Mailing address:
  • Phone: 718-737-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARTHUR YUSHUVA
Title or Position: PHYSICIAN
Credential: MD
Phone: 347-239-8882