Provider Demographics
NPI:1003446618
Name:CRUZ, SHELINA MIA (LVN)
Entity Type:Individual
Prefix:
First Name:SHELINA
Middle Name:MIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 W ANISSA CT
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93223-1200
Mailing Address - Country:US
Mailing Address - Phone:559-741-3173
Mailing Address - Fax:
Practice Address - Street 1:821 W ANISSA CT
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:CA
Practice Address - Zip Code:93223-1200
Practice Address - Country:US
Practice Address - Phone:559-741-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291184164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse