Provider Demographics
NPI:1255671251
Name:VERA CRUZ, ANGELITO II (MS ED, ATC, VATL)
Entity Type:Individual
Prefix:MR
First Name:ANGELITO
Middle Name:
Last Name:VERA CRUZ
Suffix:II
Gender:M
Credentials:MS ED, ATC, VATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 ELROD AVE
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-5113
Mailing Address - Country:US
Mailing Address - Phone:703-432-6216
Mailing Address - Fax:
Practice Address - Street 1:2189 ELROD AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5113
Practice Address - Country:US
Practice Address - Phone:703-432-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260003862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer