Provider Demographics
NPI:1407836182
Name:MATA, CRUZ (FNP)
Entity Type:Individual
Prefix:
First Name:CRUZ
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 MERTON MINTER BLVD
Mailing Address - Street 2:AUDIE MURPHY MEMORIAL VETERANS HOSPITAL
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4404
Mailing Address - Country:US
Mailing Address - Phone:269-357-6708
Mailing Address - Fax:269-357-6708
Practice Address - Street 1:7400 MERTON MINTER BLVD
Practice Address - Street 2:AUDIE MURPHY MEMORIAL VETERANS HOSPITAL
Practice Address - City:SAN ANTONIO
Practice Address - State:TEXAS
Practice Address - Zip Code:78229
Practice Address - Country:UM
Practice Address - Phone:269-357-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704150003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily