Provider Demographics
NPI:1629014709
Name:CRUZ, VALENTINA IGNACIO (PA)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:IGNACIO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9255 DALLAS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4211
Mailing Address - Country:US
Mailing Address - Phone:972-377-1490
Mailing Address - Fax:972-377-1499
Practice Address - Street 1:9255 DALLAS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4211
Practice Address - Country:US
Practice Address - Phone:972-377-1490
Practice Address - Fax:972-377-1499
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02038363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX375882301Medicaid
TX83N318Medicare PIN