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General NPI Number Information
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NPI Number | 1477176766
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Entity Type | Organization
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Legal Business Name | ELEGANZ MEDICAL SPA PLLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 3970 W 24TH ST STE 203
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City | YUMA
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State | AZ
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Zip | 85364-9261
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Country | US
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Telephone | 928-783-5634
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Fax | 928-250-1586
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Provider Business Mailing Address
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Address Line | 3970 W 24TH ST STE 203
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City | YUMA
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State | AZ
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Zip | 85364-9261
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Country | US
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Telephone | 928-783-5634
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Fax | 928-250-1586
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Authorized Official
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Title or Position | NP
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Name | MR. STEVEN M KUDER
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Credential | NP-C
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Telephone | 928-783-5634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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