Healthcare Provider Details

I. General information

NPI: 1952961831
Provider Name (Legal Business Name): DANIELA GARCIA-CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 E 9TH ST
JEFFERSONVILLE IN
47130-4018
US

IV. Provider business mailing address

503 E 9TH ST
JEFFERSONVILLE IN
47130-4018
US

V. Phone/Fax

Practice location:
  • Phone: 717-609-6596
  • Fax: 949-695-3394
Mailing address:
  • Phone: 717-609-6596
  • Fax: 949-695-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number99100919A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: