Provider Demographics
NPI:1891749313
Name:CRUZ, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4110 N 108TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5772
Mailing Address - Country:US
Mailing Address - Phone:623-772-6999
Mailing Address - Fax:623-772-6444
Practice Address - Street 1:4110 N 108TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5772
Practice Address - Country:US
Practice Address - Phone:623-772-6999
Practice Address - Fax:623-772-6444
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32943207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ884165Medicaid
AZZ118218Medicare PIN
AZ884165Medicaid
AZ884165Medicaid
AZ80872Medicare ID - Type UnspecifiedMDCR GRP WCFGW