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General NPI Number Information
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NPI Number | 1295437887
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Entity Type | Individual
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Provider Name | JENNIFER MARIE CRUZ
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 18851 UNIVERSITY BLVD STE 210
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City | SUGAR LAND
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State | TX
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Zip | 77479-6818
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Country | US
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Telephone | 281-990-0685
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Fax |
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Provider Business Mailing Address
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Address Line | 12315 MARIA HEIGHTS CT
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City | HOUSTON
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State | TX
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Zip | 77047-2110
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Country | US
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Telephone | 956-472-7039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 390200000X
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40534
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License Number State | TX
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