Provider Demographics
NPI:1659369247
Name:CRUZ-SIVILS, CARDIS MELAGROS (PA)
Entity Type:Individual
Prefix:MRS
First Name:CARDIS
Middle Name:MELAGROS
Last Name:CRUZ-SIVILS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W LAUREL DR
Mailing Address - Street 2:STE A
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3460
Mailing Address - Country:US
Mailing Address - Phone:831-905-5868
Mailing Address - Fax:
Practice Address - Street 1:275 W LAUREL DR
Practice Address - Street 2:SUITE A.
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3460
Practice Address - Country:US
Practice Address - Phone:831-755-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-09
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17387363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ14041Medicare UPIN