Basic Information
| Provider Information | |||||||||
| NPI: | 1023182227 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | COSCA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2149 E WARNER RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852843495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803930309 | ||||||||
| FaxNumber: | 4806106189 | ||||||||
| Practice Location | |||||||||
| Address1: | 1498 SOUTHGATE AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940154015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507554490 | ||||||||
| FaxNumber: | 6507552920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A96754 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 1316099658 | 01 | CA | GROUP NPI | OTHER | 1336117829 | 01 | CA | WEST BAY NEPHROLOGY ASSOCIATES'S NPI | OTHER | ZZZ27071Z | 01 | CA | GROUP CA MEDICARE | OTHER | ZZZ86010Z | 01 | CA | WEST BAY NEPHROLOGY ASSOCIATES'S TAX ID | OTHER | 1023182227 | 05 | CA | MEDICAID | ZZZ04539Z | 01 | CA | MEDICARE GROUP | OTHER |