Healthcare Provider Details

I. General information

NPI: 1376193243
Provider Name (Legal Business Name): SANDRA CRUZ-ZAMORA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 SWIFT BLVD
RICHLAND WA
99352-3514
US

IV. Provider business mailing address

10109 W MAPLE DR
PASCO WA
99301-6528
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2213
  • Fax:
Mailing address:
  • Phone: 509-316-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN60581496
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: