Provider Demographics
NPI:1770060980
Name:CENTRO DE SALUD-CRUZ
Entity type:Organization
Organization Name:CENTRO DE SALUD-CRUZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP, CNM
Authorized Official - Phone:801-560-0930
Mailing Address - Street 1:1002 E SOUTH TEMPLE STE 508
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1568
Mailing Address - Country:US
Mailing Address - Phone:801-560-0930
Mailing Address - Fax:801-531-0930
Practice Address - Street 1:1002 E SOUTH TEMPLE STE 508
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1568
Practice Address - Country:US
Practice Address - Phone:801-908-0970
Practice Address - Fax:801-531-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1538598065OtherNPI