Provider Demographics
NPI:1912573841
Name:CRUZ VENEGAS, TERESA (RDH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CRUZ VENEGAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30261 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-5953
Mailing Address - Country:US
Mailing Address - Phone:760-500-8676
Mailing Address - Fax:
Practice Address - Street 1:2204 S EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6391
Practice Address - Country:US
Practice Address - Phone:760-653-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33886124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist