Provider Demographics
NPI:1285441113
Name:CRUZ SOZA, OSWALDO JOSE
Entity type:Individual
Prefix:
First Name:OSWALDO
Middle Name:JOSE
Last Name:CRUZ SOZA
Suffix:
Gender:M
Credentials:
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 1815
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1815
Mailing Address - Country:US
Mailing Address - Phone:541-728-1022
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1815
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97709-1815
Practice Address - Country:US
Practice Address - Phone:541-728-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112863172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker