Provider Demographics
NPI:1538333513
Name:PODLISKA, MEDY CRUZ (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:MEDY
Middle Name:CRUZ
Last Name:PODLISKA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:REMEDIOS
Other - Middle Name:CRUZ
Other - Last Name:PODLISKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1602 OLD HART RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5839
Mailing Address - Country:US
Mailing Address - Phone:916-474-9743
Mailing Address - Fax:
Practice Address - Street 1:1900 T ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6822
Practice Address - Country:US
Practice Address - Phone:916-558-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17514363LW0102X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health