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General NPI Number Information
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NPI Number | 1114734902
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Entity Type | Organization
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Legal Business Name | CRUZCARE1
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 336 PRINCESS AVE APT HOME
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City | CRANSTON
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State | RI
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Zip | 02920-6915
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Country | US
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Telephone | 401-569-4691
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Fax |
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Provider Business Mailing Address
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Address Line | 336 PRINCESS AVE APT HOME
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City | CRANSTON
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State | RI
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Zip | 02920-6915
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Country | US
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Telephone | 401-569-4691
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JAMIE LEE DELACRUZ
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Credential | AGNP
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Telephone | 401-569-4691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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