Provider Demographics
NPI:1992552681
Name:CRUZ, SANDRA ANN (CM)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CM
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:ANN
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CM
Mailing Address - Street 1:1871 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3969
Mailing Address - Country:US
Mailing Address - Phone:801-231-3270
Mailing Address - Fax:
Practice Address - Street 1:1871 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3969
Practice Address - Country:US
Practice Address - Phone:801-231-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTACM-01511171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator