MEDICARE: WAYNE M CUMBRIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	34941	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629048046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE M CUMBRIA M.D.

Provider Business Mailing Address
First Line	:	3333 E CAMELBACK RD
Second Line	:	SUITE 180,
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2322
Country	:	US
Telephone Number	:	602-997-0484
Fax Number	:	602-224-3358

Provider Business Practice Location Address
First Line	:	1851 MESQUITE AVE STE 216
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5681
Country	:	US
Telephone Number	:	928-854-5358
Fax Number	:	928-854-5367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	02/22/2017

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