Provider Demographics
NPI:1033315601
Name:JIVCU, CRISTIAN N (MD)
Entity Type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:N
Last Name:JIVCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5151 E BROADWAY RD
Mailing Address - Street 2:STE 107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1346
Mailing Address - Country:US
Mailing Address - Phone:480-290-7000
Mailing Address - Fax:602-254-6840
Practice Address - Street 1:10585 N TATUM BLVD
Practice Address - Street 2:STE D130
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1073
Practice Address - Country:US
Practice Address - Phone:602-559-9966
Practice Address - Fax:602-395-8984
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ81314207R00000X
AZ42944207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ171598OtherMEDICARE
AZ945196Medicaid