Healthcare Provider Details

I. General information

NPI: 1609457936
Provider Name (Legal Business Name): MRS. TASIA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 CONSTITUTION DR
VIRGINIA BEACH VA
23462-6722
US

IV. Provider business mailing address

1415 CAPE ANN WAY APT 510
VIRGINIA BEACH VA
23453-5695
US

V. Phone/Fax

Practice location:
  • Phone: 757-262-3316
  • Fax:
Mailing address:
  • Phone: 757-777-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0730000825
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: