Provider Demographics
NPI:1316544406
Name:EUSEBIO CRUZ, TANAIRI
Entity Type:Individual
Prefix:
First Name:TANAIRI
Middle Name:
Last Name:EUSEBIO 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 1:3514 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1205
Mailing Address - Country:US
Mailing Address - Phone:347-418-4743
Mailing Address - Fax:
Practice Address - Street 1:3514 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1205
Practice Address - Country:US
Practice Address - Phone:347-418-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education