Healthcare Provider Details

I. General information

NPI: 1538598065
Provider Name (Legal Business Name): MARIA GUADALUPE CRUZ DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S 500 E STE 207
SALT LAKE CITY UT
84102-1065
US

IV. Provider business mailing address

34 S 500 E STE 207
SALT LAKE CITY UT
84102-1065
US

V. Phone/Fax

Practice location:
  • Phone: 801-560-0930
  • Fax: 801-531-0930
Mailing address:
  • Phone: 801-560-0930
  • Fax: 801-531-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200580-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number200580-4402
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200580-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: