Healthcare Provider Details

I. General information

NPI: 1922071448
Provider Name (Legal Business Name): MARISSA GALVEZ VITO CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA G VITOCRUZ MD

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 15TH ST NW
NORTON VA
24273-1616
US

IV. Provider business mailing address

1021 W OAKLAND AVE STE 310
JOHNSON CITY TN
37604-2192
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-9002
  • Fax: 276-679-9078
Mailing address:
  • Phone: 423-302-6567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101221333
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48344
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101221333
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48344
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101221333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: