MEDICARE: JOSE LUIS CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1073495594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE LUIS CRUZ

Provider Business Mailing Address
First Line	:	5126 W CONDOR DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9406
Country	:	US
Telephone Number	:	520-302-9366
Fax Number	:

Provider Business Practice Location Address
First Line	:	5126 W CONDOR DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9406
Country	:	US
Telephone Number	:	520-302-9366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	07/24/2025

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Directions to “ JOSE LUIS CRUZ ” Practice Location

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