Healthcare Provider Details

I. General information

NPI: 1306371745
Provider Name (Legal Business Name): KRISTINE ANNETTE CRUZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MAIN ST. SW
LOS LUNAS NM
87031
US

IV. Provider business mailing address

3911 4TH ST NW
ALBUQUERQUE NM
87107-2510
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-5446
  • Fax:
Mailing address:
  • Phone: 505-433-4493
  • Fax: 505-433-5271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberCNP-03216
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03216
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: