Healthcare Provider Details

I. General information

NPI: 1447025382
Provider Name (Legal Business Name): VERONICA WALLACE-CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 MAKALOA ST # 204-125
HONOLULU HI
96814-3232
US

IV. Provider business mailing address

5035 MCCORMACK RD
SCHOFIELD BARRACKS HI
96786
US

V. Phone/Fax

Practice location:
  • Phone: 910-476-7031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: