=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588061782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARINA ALYSHA CRUZ PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2014
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2270 S RIDGEVIEW DR STE 302
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-8866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-336-3170
-----------------------------------------------------
Fax | 928-722-6113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 S AVENUE A
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-7170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-344-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 5931
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------