Provider Demographics
NPI:1376865568
Name:RIVERA, CRUZ C
Entity Type:Individual
Prefix:MRS
First Name:CRUZ
Middle Name:C
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRUZ
Other - Middle Name:C
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMS
Mailing Address - Street 1:2001 E LOHMAN AVE # 110-248
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3167
Mailing Address - Country:US
Mailing Address - Phone:575-640-6393
Mailing Address - Fax:
Practice Address - Street 1:2001 E LOHMAN AVE # 110-248
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3167
Practice Address - Country:US
Practice Address - Phone:575-640-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator