Healthcare Provider Details

I. General information

NPI: 1053238352
Provider Name (Legal Business Name): BRENDA AMALIN CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2877 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-2312
US

IV. Provider business mailing address

2429 SPLIT ROCK DR
COLORADO SPRINGS CO
80919-3046
US

V. Phone/Fax

Practice location:
  • Phone: 719-493-9903
  • Fax:
Mailing address:
  • Phone: 719-433-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: