Provider Demographics
NPI:1689844540
Name:CRUZ, ELIZABETE RANGEL (LMP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETE
Middle Name:RANGEL
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SE SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2340
Mailing Address - Country:US
Mailing Address - Phone:509-332-5602
Mailing Address - Fax:
Practice Address - Street 1:200 S ALMON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2098
Practice Address - Country:US
Practice Address - Phone:208-882-8534
Practice Address - Fax:208-882-6866
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024192172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist