Provider Demographics
NPI:1992385603
Name:CRUZ, ROSA ELIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ELIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-1933
Mailing Address - Country:US
Mailing Address - Phone:956-771-0871
Mailing Address - Fax:
Practice Address - Street 1:1589 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1933
Practice Address - Country:US
Practice Address - Phone:956-771-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant