Provider Demographics
NPI:1982829677
Name:CRUZ, NOEMI (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NOEMI
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 MIDHURST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5430
Mailing Address - Country:US
Mailing Address - Phone:682-365-9277
Mailing Address - Fax:
Practice Address - Street 1:2214 MIDHURST DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5430
Practice Address - Country:US
Practice Address - Phone:682-365-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14940235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81S585OtherBLUE CROSS BLUE SHIELD
TX004222803Medicaid