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NPI Code Detail

MEDICARE: GABRIELLA SANTACRUZ PSYD

MEDICARE: GABRIELLA SANTACRUZ PSYD
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
1103TC2200XClinical Child & Adolescent PsychologistPSY-005179AZ

General Provider Information

NPI Number : 1730478850
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLA SANTACRUZ PSYD
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 602-933-1000
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-0414
Fax Number : 602-933-4252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2011
Last Update Date : 04/30/2026

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