Provider Demographics
NPI:1396734703
Name:ESCALONA-CRUZ, RELPHA (MD)
Entity type:Individual
Prefix:
First Name:RELPHA
Middle Name:
Last Name:ESCALONA-CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 LOCKS WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4976
Mailing Address - Country:US
Mailing Address - Phone:706-231-5993
Mailing Address - Fax:706-868-0929
Practice Address - Street 1:1113 GARREDD BLVD STE B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6674
Practice Address - Country:US
Practice Address - Phone:706-868-0919
Practice Address - Fax:706-868-0929
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051131208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000940354EMedicaid
GA000940354CMedicaid
GA000940354DMedicaid
GA000940354AMedicaid
SCGA1138Medicaid
TX8L19807Medicare PIN
GA000940354EMedicaid
SCGA1138Medicaid
GAH55791Medicare UPIN