Provider Demographics
NPI:1467896951
Name:LOPEZ CRUZ, BLANCA A
Entity Type:Individual
Prefix:MRS
First Name:BLANCA
Middle Name:A
Last Name:LOPEZ CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3804 ALLISON STREET
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722
Mailing Address - Country:US
Mailing Address - Phone:202-492-0740
Mailing Address - Fax:
Practice Address - Street 1:1752 COLUMBIA RD NW STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-8837
Practice Address - Country:US
Practice Address - Phone:202-808-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide