Provider Demographics
NPI:1982734307
Name:CRUZ, EUGENE REYES (LMP)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:REYES
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15113 87TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-8415
Mailing Address - Country:US
Mailing Address - Phone:253-230-3659
Mailing Address - Fax:
Practice Address - Street 1:5800 SOUNDVIEW DR
Practice Address - Street 2:SUITE C-101
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2000
Practice Address - Country:US
Practice Address - Phone:253-858-4845
Practice Address - Fax:253-857-8305
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist