Provider Demographics
NPI:1114504255
Name:CRUZ ALFONSO, BEVERLEY (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:
Last Name:CRUZ ALFONSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEVERLEY
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1959 NE PACIFIC ST BOX 356460
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4245 ROOSEVELT WAY NE FL 4
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6008
Practice Address - Country:US
Practice Address - Phone:206-598-5500
Practice Address - Fax:206-598-8722
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program