Healthcare Provider Details

I. General information

NPI: 1740037258
Provider Name (Legal Business Name): CLAUDIA CRUZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAUDIA CRUZ CRUZ

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 CAJA DEL ORO GRANT RD
SANTA FE NM
87507-3279
US

IV. Provider business mailing address

3512 PLACITA REAL LOOP
SANTA FE NM
87507-4908
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59494
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: