Provider Demographics
NPI:1073351789
Name:CRUZ, MARLENE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
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:POB 500053
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0053
Mailing Address - Country:US
Mailing Address - Phone:670-233-4646
Mailing Address - Fax:670-233-4648
Practice Address - Street 1:MARIANAS HEALTH LLC BUILDING SUITE 204
Practice Address - Street 2:GHIYEGHI ST SAN JOSE
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-8903
Practice Address - Country:US
Practice Address - Phone:670-233-4646
Practice Address - Fax:670-233-4648
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1081196171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach