MEDICARE: KELLY L CRUZ CAREGIVER

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1649826231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY L CRUZ CAREGIVER

Provider Business Mailing Address
First Line	:	PO BOX 57038
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85732-7038
Country	:	US
Telephone Number	:	520-850-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	7480 E MOUNTAIN QUAIL CIR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-6215
Country	:	US
Telephone Number	:	520-577-0343
Fax Number	:

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

Provider Enumeration Date	:	08/10/2019
Last Update Date	:	08/10/2019

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Directions to “ KELLY L CRUZ CAREGIVER” Practice Location

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