Provider Demographics
NPI:1689966715
Name:SOL CRUZ, DENNIS PESTANO (0260069813)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:PESTANO
Last Name:SOL CRUZ
Suffix:
Gender:M
Credentials:0260069813
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9777
Mailing Address - Country:US
Mailing Address - Phone:802-748-9613
Mailing Address - Fax:
Practice Address - Street 1:762 MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9777
Practice Address - Country:US
Practice Address - Phone:802-748-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0069813163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse