Provider Demographics
NPI:1942567383
Name:GOMEZ-CRUZ, BLANCA (R065303)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:GOMEZ-CRUZ
Suffix:
Gender:F
Credentials:R065303
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 PEABODY ST NW APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1850
Mailing Address - Country:US
Mailing Address - Phone:301-256-2567
Mailing Address - Fax:
Practice Address - Street 1:1370 PEABODY ST NW APT 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1850
Practice Address - Country:US
Practice Address - Phone:301-256-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR065303374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide