Provider Demographics
NPI:1083856629
Name:CRUZ, MARJORIE GUERRERO (RN)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:GUERRERO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 CLEARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2411
Mailing Address - Country:US
Mailing Address - Phone:571-243-5486
Mailing Address - Fax:
Practice Address - Street 1:6490 WOLF RUN SHOALS RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1742
Practice Address - Country:US
Practice Address - Phone:703-250-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001104501376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator