Provider Demographics
NPI:1104113992
Name:RIESTRA-CRUZ, MARIA EUGENIA (ADULT FOSTER CARE)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:EUGENIA
Last Name:RIESTRA-CRUZ
Suffix:
Gender:F
Credentials:ADULT FOSTER CARE
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:RIESTRA-CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADULT COMPANION
Mailing Address - Street 1:4335 MISTY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1206
Mailing Address - Country:US
Mailing Address - Phone:210-264-8900
Mailing Address - Fax:
Practice Address - Street 1:4335 MISTY SPRINGS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1206
Practice Address - Country:US
Practice Address - Phone:210-264-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372600000X372600000X
225XG0600X, 2278H0200X
TX2278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
No372600000XNursing Service Related ProvidersAdult Companion
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology