Healthcare Provider Details

I. General information

NPI: 1114449550
Provider Name (Legal Business Name): YENNY A CRUZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOLLY SPRINGS RD
HOLLY SPRINGS NC
27540-6204
US

IV. Provider business mailing address

339 LEYLAND CYPRESS LN
FUQUAY VARINA NC
27526-2574
US

V. Phone/Fax

Practice location:
  • Phone: 919-762-5113
  • Fax:
Mailing address:
  • Phone: 347-488-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2022-02672
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP06160
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: