Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 14218 | NH |
N | 111NI0900X | Internist | 14218 | NH |
Y | 207R00000X | Internist | 276933 | MA |
Y | 111NI0900X | Internist | 276933 | MA |
N | 207RA0401X | Internist - Addiction Medicine | 276933 | MA |
NPI | 1821228727 |
---|---|
Provider Name | Dr. Maireni R Cruz |
First Address | Middleton, WI 53562-5531 |
Second Address | Athol, MA 01331-4901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 30/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RE8109 | (02) | NH |