Provider Demographics
NPI:1245547447
Name:CRUZ, LESIA ELLIOTT (PT & HC)
Entity type:Individual
Prefix:MRS
First Name:LESIA
Middle Name:ELLIOTT
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PT & HC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-3019
Mailing Address - Country:US
Mailing Address - Phone:828-682-6157
Mailing Address - Fax:828-682-6158
Practice Address - Street 1:390 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3019
Practice Address - Country:US
Practice Address - Phone:828-682-6157
Practice Address - Fax:828-682-6158
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34892907133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education