Provider Demographics
NPI:1225213788
Name:CRUZ, VIVIAN G (CMT, EMT)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:G
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CMT, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GEORGIA ST.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590
Mailing Address - Country:US
Mailing Address - Phone:707-655-0454
Mailing Address - Fax:707-647-2604
Practice Address - Street 1:301 GEORGIA ST
Practice Address - Street 2:SUITE 210
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5946
Practice Address - Country:US
Practice Address - Phone:707-655-0454
Practice Address - Fax:707-647-2604
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist