Healthcare Provider Details

I. General information

NPI: 1275470692
Provider Name (Legal Business Name): ANGELA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

13334 VERNON AVE
LUBBOCK TX
79423-4586
US

V. Phone/Fax

Practice location:
  • Phone: 806-775-8200
  • Fax:
Mailing address:
  • Phone: 619-861-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1160819
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: