Healthcare Provider Details

I. General information

NPI: 1083029961
Provider Name (Legal Business Name): BALBINA CRUZ-VAZQUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE
ROCHESTER NY
14621-3001
US

IV. Provider business mailing address

1425 PORTLAND AVE
ROCHESTER NY
14621-3001
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4022
  • Fax: 585-922-9371
Mailing address:
  • Phone: 585-922-4022
  • Fax: 585-922-9371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number444203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: