Provider Demographics
NPI:1073126827
Name:CRUZ MORENO, JOSEFINA
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:
Last Name:CRUZ MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4622 S GAZELLE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-5636
Mailing Address - Country:US
Mailing Address - Phone:206-228-6547
Mailing Address - Fax:
Practice Address - Street 1:4622 S GAZELLE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5636
Practice Address - Country:US
Practice Address - Phone:206-228-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0286881OtherL&I PROVIDER NUMBER