Provider Demographics
NPI:1881077279
Name:DIGESTIVE HEALTH & WELLNESS, LLC
Entity type:Organization
Organization Name:DIGESTIVE HEALTH & WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-398-4694
Mailing Address - Street 1:4110 N 108TH AVE
Mailing Address - Street 2:STE. 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5772
Mailing Address - Country:US
Mailing Address - Phone:623-772-6999
Mailing Address - Fax:623-772-6444
Practice Address - Street 1:4110 N 108TH AVE
Practice Address - Street 2:STE. 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5772
Practice Address - Country:US
Practice Address - Phone:623-772-6999
Practice Address - Fax:623-772-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32943207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty