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General NPI Number Information
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NPI Number | 1649884248
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Entity Type | Individual
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Provider Name | JOSE G. CRUZ RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 1020 PARK AVE
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City | CRANSTON
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State | RI
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Zip | 02910-3227
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Country | US
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Telephone | 401-396-7649
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Fax |
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Provider Business Mailing Address
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Address Line | 66 PLANET AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-2172
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Country | US
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Telephone | 401-396-7649
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SAP173871
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CADC-200884
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDP00711
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License Number State | RI
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