Provider Demographics
NPI:1154886851
Name:CRUZ, MAYTE ALONDRA
Entity type:Individual
Prefix:
First Name:MAYTE
Middle Name:ALONDRA
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 1:1401 ALMOND AVE # 20
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-5043
Mailing Address - Country:US
Mailing Address - Phone:925-273-4220
Mailing Address - Fax:
Practice Address - Street 1:1401 ALMOND AVE # 20
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-5043
Practice Address - Country:US
Practice Address - Phone:925-273-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker