Healthcare Provider Details

I. General information

NPI: 1205790193
Provider Name (Legal Business Name): DESIRAE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W WETMORE RD
TUCSON AZ
85705-1547
US

IV. Provider business mailing address

701 W WETMORE RD
TUCSON AZ
85705-1547
US

V. Phone/Fax

Practice location:
  • Phone: 520-696-5234
  • Fax: 520-696-5067
Mailing address:
  • Phone: 520-696-5234
  • Fax: 520-696-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA16857
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: