Provider Demographics
NPI:1417776600
Name:CRUZ, JAIME (CMI)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:CMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 FOWLER ST APT 38
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4816
Mailing Address - Country:US
Mailing Address - Phone:509-302-5235
Mailing Address - Fax:
Practice Address - Street 1:1878 FOWLER ST APT 38
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4816
Practice Address - Country:US
Practice Address - Phone:509-302-5235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA12348171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter