Provider Demographics
NPI:1639309107
Name:CRUZ, SANDY
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
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 1:561 W 91ST CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6893
Mailing Address - Country:US
Mailing Address - Phone:303-429-9551
Mailing Address - Fax:
Practice Address - Street 1:561 W 91ST CIR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6893
Practice Address - Country:US
Practice Address - Phone:303-429-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician