Provider Demographics
NPI:1588968291
Name:CRUZ, JOSE MOURICIO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:MOURICIO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:M
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1035 DAIRY ASHFORD ST
Mailing Address - Street 2:# 216
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-4600
Mailing Address - Country:US
Mailing Address - Phone:713-560-5871
Mailing Address - Fax:
Practice Address - Street 1:1035 DAIRY ASHFORD
Practice Address - Street 2:# 216
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-4600
Practice Address - Country:US
Practice Address - Phone:713-560-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT043034OtherMASSAGE THERAIST CERTIFICATION