Provider Demographics
NPI:1124898721
Name:CRUZ, AHYSSA RENAY (PHD)
Entity type:Individual
Prefix:DR
First Name:AHYSSA
Middle Name:RENAY
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78595-1195
Mailing Address - Country:US
Mailing Address - Phone:956-648-5225
Mailing Address - Fax:
Practice Address - Street 1:211 E EXPRESSWAY 83 STE E
Practice Address - Street 2:
Practice Address - City:SULLIVAN CITY
Practice Address - State:TX
Practice Address - Zip Code:78595-2011
Practice Address - Country:US
Practice Address - Phone:956-709-8714
Practice Address - Fax:956-291-3633
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider