MEDICARE: SUSANA 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	164W00000X	Licensed Practical Nurse	311499	NY

General Provider Information

NPI Number	:	1750621108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA CRUZ

Provider Business Mailing Address
First Line	:	4627 WILD IRIS DR APT 203
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-8746
Country	:	US
Telephone Number	:	845-248-5786
Fax Number	:

Provider Business Practice Location Address
First Line	:	4627 WILD IRIS DR APT 203
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-8746
Country	:	US
Telephone Number	:	845-248-5786
Fax Number	:

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

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	07/26/2021

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Directions to “ SUSANA CRUZ ” Practice Location

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