Provider Demographics
NPI:1669079109
Name:ELIZABETH YUSHUVA RPAC, PLLC
Entity type:Organization
Organization Name:ELIZABETH YUSHUVA RPAC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSHUVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-239-8882
Mailing Address - Street 1:23220 N 71ST DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5872
Mailing Address - Country:US
Mailing Address - Phone:718-737-6972
Mailing Address - Fax:
Practice Address - Street 1:23220 N 71ST DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5872
Practice Address - Country:US
Practice Address - Phone:718-737-6972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty