Provider Demographics
NPI:1467726711
Name:CRUZ, RIGOBERTO
Entity Type:Individual
Prefix:
First Name:RIGOBERTO
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 E MCKINNEY ST
Mailing Address - Street 2:900
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-4595
Mailing Address - Country:US
Mailing Address - Phone:940-808-0901
Mailing Address - Fax:940-808-0928
Practice Address - Street 1:1607 E MCKINNEY ST
Practice Address - Street 2:900
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-4595
Practice Address - Country:US
Practice Address - Phone:940-808-0901
Practice Address - Fax:940-808-0928
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician