Individual
JESSICA ALEXANDRA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
213 N MAIN ST, MOSCOW, ID 83843-2700
(208) 882-7565
(208) 882-7567
Mailing address
1030 LEEPIKE CT, MOSCOW, ID 83843-6008
(208) 669-2777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1795
ID
Other
Enumeration date
09/30/2019
Last updated
09/30/2019
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