Provider Demographics
NPI:1659702447
Name:CRUZ, HEATHER DOOLEY (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DOOLEY
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4916
Mailing Address - Country:US
Mailing Address - Phone:415-269-1969
Mailing Address - Fax:
Practice Address - Street 1:995 POTRERO AVE # WARD93
Practice Address - Street 2:BUILDING 90, 3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2859
Practice Address - Country:US
Practice Address - Phone:415-206-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805212163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse