Provider Demographics
NPI:1609485762
Name:CRUZ, AMANDA ELAINE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELAINE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELAINE
Other - Last Name:TUGGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1605 NW 30TH ST APT 228
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-3622
Mailing Address - Country:US
Mailing Address - Phone:405-219-1303
Mailing Address - Fax:
Practice Address - Street 1:1605 NW 30TH ST APT 228
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-3622
Practice Address - Country:US
Practice Address - Phone:405-219-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist