Provider Demographics
NPI:1164207510
Name:CRUZ, MAZELINE (CNM)
Entity Type:Individual
Prefix:
First Name:MAZELINE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 W BAKER RD STE A
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2285
Mailing Address - Country:US
Mailing Address - Phone:281-837-2100
Mailing Address - Fax:
Practice Address - Street 1:1674 W BAKER RD STE A
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2285
Practice Address - Country:US
Practice Address - Phone:281-837-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130674367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife