Provider Demographics
NPI:1225273469
Name:CRUZ, VINA SADANG (DO)
Entity Type:Individual
Prefix:DR
First Name:VINA
Middle Name:SADANG
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 159TH AVE NE BLDG 21
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6309
Mailing Address - Country:US
Mailing Address - Phone:425-216-0550
Mailing Address - Fax:
Practice Address - Street 1:3925 159TH AVE NE BLDG 21
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6309
Practice Address - Country:US
Practice Address - Phone:425-216-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61185876207Q00000X
NY255656-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine