Provider Demographics
NPI:1982336079
Name:CRUZ, AIXA DESTINEE
Entity Type:Individual
Prefix:
First Name:AIXA
Middle Name:DESTINEE
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 1:5 MCCORMICK CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6460
Mailing Address - Country:US
Mailing Address - Phone:860-402-0199
Mailing Address - Fax:
Practice Address - Street 1:4400 JENIFER ST NW STE 280
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2113
Practice Address - Country:US
Practice Address - Phone:301-367-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program