Healthcare Provider Details

I. General information

NPI: 1437039997
Provider Name (Legal Business Name): MELY PAZ CRUZ CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

2604 MARY PL
FORT WASHINGTON MD
20744-2428
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-7543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136001068
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: