Provider Demographics
NPI:1346859782
Name:CRUZ, LISA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CACTUS CREEK PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5843
Mailing Address - Country:US
Mailing Address - Phone:915-401-0314
Mailing Address - Fax:
Practice Address - Street 1:604 CACTUS CREEK PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-5843
Practice Address - Country:US
Practice Address - Phone:915-401-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006572164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse