Provider Demographics
NPI:1861740227
Name:CRUZ, VANESSA (CASAC, ICADC)
Entity type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CASAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 W 142ND ST
Mailing Address - Street 2:APT.34
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6728
Mailing Address - Country:US
Mailing Address - Phone:347-812-7092
Mailing Address - Fax:
Practice Address - Street 1:5080 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1138
Practice Address - Country:US
Practice Address - Phone:212-795-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program