Provider Demographics
NPI:1356381578
Name:RUMBA MCCORMICK, KRISTEN F (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:F
Last Name:RUMBA MCCORMICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:F
Other - Last Name:RUMBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:5601 W EUGIE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1256
Mailing Address - Country:US
Mailing Address - Phone:602-521-6200
Mailing Address - Fax:
Practice Address - Street 1:9201 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3332
Practice Address - Country:US
Practice Address - Phone:623-327-5923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ098338Medicaid