Provider Demographics
NPI:1881288918
Name:CRUZ, KRISTIANA MARIAH
Entity type:Individual
Prefix:
First Name:KRISTIANA
Middle Name:MARIAH
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 1:4000 E RENNER RD APT 1631
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2717
Mailing Address - Country:US
Mailing Address - Phone:956-832-4950
Mailing Address - Fax:
Practice Address - Street 1:2701 AIRPORT FWY STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-2378
Practice Address - Country:US
Practice Address - Phone:682-564-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist