Provider Demographics
NPI:1700018991
Name:TOMACRUZ, YVETTE CORINNE (MD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:CORINNE
Last Name:TOMACRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1126 SLIDE RD
Mailing Address - Street 2:SUITE 4-B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5402
Mailing Address - Country:US
Mailing Address - Phone:806-793-8447
Mailing Address - Fax:806-793-0498
Practice Address - Street 1:1126 SLIDE RD
Practice Address - Street 2:SUITE 4-B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-5402
Practice Address - Country:US
Practice Address - Phone:806-793-8447
Practice Address - Fax:806-793-0498
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFT1597294OtherCONTROLLED SUBSTANCE REGISTRATION CERTIAFICATE
TXN0167574OtherDPS CERTIFICATE