Provider Demographics
NPI:1235562513
Name:SANTA CRUZ-GORDON, MARGARITA PILAR (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:PILAR
Last Name:SANTA CRUZ-GORDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 E STELLA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-2716
Mailing Address - Country:US
Mailing Address - Phone:520-886-2191
Mailing Address - Fax:
Practice Address - Street 1:5000 E ANDREW ST
Practice Address - Street 2:MYERS/GANOUNG ELEMENTRY
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-584-6700
Practice Address - Fax:520-584-6701
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP046249164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse