Healthcare Provider Details

I. General information

NPI: 1558890301
Provider Name (Legal Business Name): VIVIANA VICTORIA CRUZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4856 INNOVATION DR
FORT COLLINS CO
80525-5539
US

IV. Provider business mailing address

4856 INNOVATION DR
FORT COLLINS CO
80525-5539
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-4200
  • Fax: 844-270-1824
Mailing address:
  • Phone: 970-494-4200
  • Fax: 844-270-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0003000
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0023931
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: