Basic Information
| Provider Information | |||||||||
| NPI: | 1558318931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | FRANK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 S 336TH ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538386180 | ||||||||
| FaxNumber: | 2538386418 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 E WHEELER RD | ||||||||
| Address2: | |||||||||
| City: | MOSES LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988371820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097661301 | ||||||||
| FaxNumber: | 5097661306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 03/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD00030781 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | MD00030781 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 168133 | 05 | OR | MEDICAID | 0219430 | 01 | WA | LIWA | OTHER | 7683CR | 01 | WA | BSWA | OTHER | 9765CR | 01 | WA | BSWA | OTHER | 8147647 | 05 | WA | MEDICAID |