Provider Demographics
NPI:1235910712
Name:CRUZ, JACQUELINE ENID
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ENID
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GRIFFITH ST UNIT 703
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-2606
Mailing Address - Country:US
Mailing Address - Phone:330-720-7897
Mailing Address - Fax:
Practice Address - Street 1:516 GRIFFITH ST UNIT 703
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-2606
Practice Address - Country:US
Practice Address - Phone:330-720-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide