Provider Demographics
NPI:1952025637
Name:CRUZ, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 W ROCK CREEK RD APT 401
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4820
Mailing Address - Country:US
Mailing Address - Phone:918-695-4282
Mailing Address - Fax:
Practice Address - Street 1:3730 W ROCK CREEK RD APT 401
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4820
Practice Address - Country:US
Practice Address - Phone:918-695-4282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator