Provider Demographics
NPI:1841559614
Name:CRUZ, KATHERINE LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LOUISE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 ARTHUR AVENUE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057
Mailing Address - Country:US
Mailing Address - Phone:760-717-7655
Mailing Address - Fax:
Practice Address - Street 1:5730 RIVERSIDE DRIVE BLDG 652
Practice Address - Street 2:
Practice Address - City:MARCH ARB
Practice Address - State:CA
Practice Address - Zip Code:92518
Practice Address - Country:US
Practice Address - Phone:951-655-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529526163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse