Provider Demographics
NPI:1962041806
Name:CRUZ, ASTRID (ASTRI)
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:ASTRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-1989
Mailing Address - Country:US
Mailing Address - Phone:401-390-8768
Mailing Address - Fax:
Practice Address - Street 1:133 PERRY ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-1989
Practice Address - Country:US
Practice Address - Phone:401-390-8768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINA46024376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1000484462Medicaid