Healthcare Provider Details

I. General information

NPI: 1750573226
Provider Name (Legal Business Name): JULIAN XAVIER CRUZ C.S.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 PENNSYLVANIA AVE SUITE 100
FORT WORTH TX
76104
US

IV. Provider business mailing address

P. O. BOX 961205
FORT WORTH TX
76161-1205
US

V. Phone/Fax

Practice location:
  • Phone: 817-920-0484
  • Fax: 817-920-0068
Mailing address:
  • Phone: 817-740-8400
  • Fax: 817-378-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberNBSTSA # 050195
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: