Provider Demographics
NPI:1033904115
Name:CRUZ, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
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 1:1649 61ST ST FL 3013
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55620 202ND ST
Practice Address - Street 2:
Practice Address - City:PACIFIC JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:51561-4262
Practice Address - Country:US
Practice Address - Phone:712-308-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician