Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A96754 | CA |
NPI | 1023182227 |
---|---|
Provider Name | Dr. Christian Cosca Cruz |
First Address | Tempe, AZ 85284-3495 |
Second Address | Daly City, CA 94015-4015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 26/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023182227 | (05) | CA |
1316099658 | GROUP NPI (01) | CA |
1336117829 | WEST BAY NEPHROLOGY ASSOCIATES'S NPI (01) | CA |
I66815 | (02) | CA |
ZZZ04539Z | MEDICARE GROUP (01) | CA |
ZZZ27071Z | GROUP CA MEDICARE (01) | CA |
ZZZ86010Z | WEST BAY NEPHROLOGY ASSOCIATES'S TAX ID (01) | CA |