Healthcare Provider Details

I. General information

NPI: 1174767834
Provider Name (Legal Business Name): DIGESTIVE HEALTHCARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2009
Last Update Date: 04/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 W CAMELBACK RD SUITE 102
PHOENIX AZ
85037-1355
US

IV. Provider business mailing address

9515 W CAMELBACK RD SUITE 102
PHOENIX AZ
85037-1355
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-6999
  • Fax: 623-772-6444
Mailing address:
  • Phone: 623-772-6999
  • Fax: 623-772-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number32943
License Number StateAZ

VIII. Authorized Official

Name: ELIZABETH CRUZ
Title or Position: OWNER
Credential: M.D.
Phone: 623-772-6999