Provider Demographics
NPI:1316108756
Name:CRUZ, MARISSA ORDONEZ (DO)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:ORDONEZ
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 ALCORN DR STE 109
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9302
Mailing Address - Country:US
Mailing Address - Phone:662-293-1680
Mailing Address - Fax:662-293-1595
Practice Address - Street 1:703 ALCORN DR STE 109
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9302
Practice Address - Country:US
Practice Address - Phone:662-293-1680
Practice Address - Fax:662-293-1595
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine