Provider Demographics
NPI:1457570202
Name:CRUZ, VERONICA L (VN214719)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:L
Last Name:CRUZ
Suffix:
Gender:F
Credentials:VN214719
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:L
Other - Last Name:RUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 E LEXINGTON AVE
Mailing Address - Street 2:# 57
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1988
Mailing Address - Country:US
Mailing Address - Phone:619-334-3915
Mailing Address - Fax:
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN214719164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse