Provider Demographics
NPI:1326261587
Name:CRUZ, MIRIAM MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:MARTIN
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:MARTIN
Other - Last Name:COSCA-CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:463 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3248
Mailing Address - Country:US
Mailing Address - Phone:650-359-1460
Mailing Address - Fax:
Practice Address - Street 1:463 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3248
Practice Address - Country:US
Practice Address - Phone:650-359-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC513332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry