Provider Demographics
NPI:1104526896
Name:CRUZ, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
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 1:702 E GRIFFIN PKWY STE 3C
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2931
Mailing Address - Country:US
Mailing Address - Phone:956-600-8774
Mailing Address - Fax:956-600-7934
Practice Address - Street 1:702 E GRIFFIN PKWY STE 3C
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2931
Practice Address - Country:US
Practice Address - Phone:956-600-8774
Practice Address - Fax:956-600-7934
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies