Provider Demographics
NPI:1376821488
Name:CRUZ, WAYNE (ATP)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1908
Mailing Address - Country:US
Mailing Address - Phone:512-458-4589
Mailing Address - Fax:
Practice Address - Street 1:5400 N LAMAR BLVD
Practice Address - Street 2:203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1837
Practice Address - Country:US
Practice Address - Phone:512-458-4589
Practice Address - Fax:512-206-0955
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other