Provider Demographics
NPI:1114093192
Name:CRUZ, NORMA I (RD,CDE)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:I
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:I
Other - Last Name:CRUZ-KABIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:2916 CHARLESTON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2704
Mailing Address - Country:US
Mailing Address - Phone:505-881-0363
Mailing Address - Fax:
Practice Address - Street 1:801 VASSAR DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2725
Practice Address - Country:US
Practice Address - Phone:505-248-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM045133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered