Provider Demographics
NPI:1649450123
Name:CRUZ, VERONICA
Entity type:Individual
Prefix:MRS
First Name:VERONICA
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 1:5349 CORA WAY
Mailing Address - Street 2:
Mailing Address - City:KEYES
Mailing Address - State:CA
Mailing Address - Zip Code:95328-9714
Mailing Address - Country:US
Mailing Address - Phone:209-652-0624
Mailing Address - Fax:209-558-8315
Practice Address - Street 1:830 SCENIC DR BLDG 3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-558-7400
Practice Address - Fax:209-558-8315
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker