Provider Demographics
NPI:1689293607
Name:CRUZ, GINA SUZANNE (BCCS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:SUZANNE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:BCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 N LOOP 1604 E STE 1302
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1393
Mailing Address - Country:US
Mailing Address - Phone:210-967-6278
Mailing Address - Fax:
Practice Address - Street 1:1270 N LOOP 1604 E STE 1302
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1393
Practice Address - Country:US
Practice Address - Phone:210-967-6278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner