Healthcare Provider Details

I. General information

NPI: 1639309107
Provider Name (Legal Business Name): SANDY CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2009
Last Update Date: 07/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W 91ST CIR
THORNTON CO
80260-6893
US

IV. Provider business mailing address

561 W 91ST CIR
THORNTON CO
80260-6893
US

V. Phone/Fax

Practice location:
  • Phone: 303-429-9551
  • Fax:
Mailing address:
  • Phone: 303-429-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: