Provider Demographics
NPI:1992211536
Name:CRUZ, EDNA IRIS (AA, CPC)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:IRIS
Last Name:CRUZ
Suffix:
Gender:F
Credentials:AA, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 48TH PL W APT 3D
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3752
Mailing Address - Country:US
Mailing Address - Phone:801-651-7817
Mailing Address - Fax:
Practice Address - Street 1:3322 BROADWAY # MS 04
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4425
Practice Address - Country:US
Practice Address - Phone:425-349-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist