Provider Demographics
NPI:1528569365
Name:CRUZ, ELIZA TANIA
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:TANIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1052
Mailing Address - Country:US
Mailing Address - Phone:978-686-8980
Mailing Address - Fax:161-741-5779
Practice Address - Street 1:248 BROADWAY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1052
Practice Address - Country:US
Practice Address - Phone:978-686-8980
Practice Address - Fax:161-741-5779
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator