=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962642470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | D'LEAH CRUZ RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2009
-----------------------------------------------------
Last Update Date | 09/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10180 SE SUNNYSIDE RD SUITE B, 1ST FLOOR
-----------------------------------------------------
City | CLACKAMAS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97015-8970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-571-0905
-----------------------------------------------------
Fax | 503-517-0867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8844 SW ROMAL CT
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97008-7290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-780-5508
-----------------------------------------------------
Fax | 503-641-8003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 096006061RN
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 096006061RN
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------