Provider Demographics
NPI:1699055699
Name:CRUZ, ELIZABETH MENDOZA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MENDOZA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N 4TH ST # 344
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4487
Mailing Address - Country:US
Mailing Address - Phone:916-792-2136
Mailing Address - Fax:
Practice Address - Street 1:600 N 4TH ST APT 344
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4487
Practice Address - Country:US
Practice Address - Phone:916-792-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant