Healthcare Provider Details

I. General information

NPI: 1780332262
Provider Name (Legal Business Name): LORENA CRUZ-HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 DIVISION AVE S
GRAND RAPIDS MI
49503-5112
US

IV. Provider business mailing address

574 DIVISION AVE S
GRAND RAPIDS MI
49503-5112
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-8229
  • Fax: 616-236-4253
Mailing address:
  • Phone: 616-209-8229
  • Fax: 616-236-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: