Provider Demographics
NPI:1225205545
Name:CRUZ, MARIA VICTORIA (LMP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:M.
Other - Middle Name:VICTORIA
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:5343 TALLMAN AVE NW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3931
Mailing Address - Country:US
Mailing Address - Phone:206-784-7448
Mailing Address - Fax:206-706-0899
Practice Address - Street 1:5343 TALLMAN AVE NW
Practice Address - Street 2:SUITE 104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3931
Practice Address - Country:US
Practice Address - Phone:206-784-7448
Practice Address - Fax:206-706-0899
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist