Provider Demographics
NPI:1083015226
Name:CRUZ, SANDRA DEE
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DEE
Last Name:CRUZ
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 1:5663 KINGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-1521
Mailing Address - Country:US
Mailing Address - Phone:219-730-6777
Mailing Address - Fax:
Practice Address - Street 1:332 W. HWY 6
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46368-5885
Practice Address - Country:US
Practice Address - Phone:219-764-4888
Practice Address - Fax:219-764-7676
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist