Provider Demographics
NPI:1023182227
Name:CRUZ, CHRISTIAN COSCA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:COSCA
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 E WARNER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3495
Mailing Address - Country:US
Mailing Address - Phone:480-393-0309
Mailing Address - Fax:480-610-6189
Practice Address - Street 1:1498 SOUTHGATE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4015
Practice Address - Country:US
Practice Address - Phone:650-755-4490
Practice Address - Fax:650-755-2920
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96754207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316099658OtherGROUP NPI
CA1336117829OtherWEST BAY NEPHROLOGY ASSOCIATES'S NPI
CAZZZ27071ZOtherGROUP CA MEDICARE
CAZZZ86010ZOtherWEST BAY NEPHROLOGY ASSOCIATES'S TAX ID
CA1023182227Medicaid
CAZZZ04539ZOtherMEDICARE GROUP
CAZZZ86010ZOtherWEST BAY NEPHROLOGY ASSOCIATES'S TAX ID
CAZZZ04539ZOtherMEDICARE GROUP
CA1316099658OtherGROUP NPI