Provider Demographics
NPI:1275392839
Name:CRUZ, JOANNE KAYE TIZON
Entity Type:Individual
Prefix:
First Name:JOANNE KAYE
Middle Name:TIZON
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 1:1175 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-1729
Mailing Address - Country:US
Mailing Address - Phone:415-345-1079
Mailing Address - Fax:415-673-3749
Practice Address - Street 1:1175 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-1729
Practice Address - Country:US
Practice Address - Phone:415-345-1079
Practice Address - Fax:415-673-3749
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist