Provider Demographics
NPI:1134310733
Name:CRUZ, MAUREENE (RN, PHN)
Entity Type:Individual
Prefix:MS
First Name:MAUREENE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 BORK AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3701
Mailing Address - Country:US
Mailing Address - Phone:626-330-1209
Mailing Address - Fax:
Practice Address - Street 1:1719 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-834-8181
Practice Address - Fax:714-834-8196
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541130163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health