Provider Demographics
NPI:1992963458
Name:CRUZ, DEBRA MICHELE
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:MICHELE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:MICHELE
Other - Last Name:LLANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26161 ALGONQUIN CT
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1740
Mailing Address - Country:US
Mailing Address - Phone:734-309-2168
Mailing Address - Fax:
Practice Address - Street 1:19401 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2277
Practice Address - Country:US
Practice Address - Phone:734-785-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant