Provider Demographics
NPI:1477176766
Name:ELEGANZ MEDICAL SPA PLLC
Entity Type:Organization
Organization Name:ELEGANZ MEDICAL SPA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUDER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:928-783-5634
Mailing Address - Street 1:3970 W 24TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-9261
Mailing Address - Country:US
Mailing Address - Phone:928-783-5634
Mailing Address - Fax:928-250-1586
Practice Address - Street 1:3970 W 24TH ST STE 203
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-9261
Practice Address - Country:US
Practice Address - Phone:928-783-5634
Practice Address - Fax:928-250-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty