Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 32873 | TX |
NPI | 1003011263 |
---|---|
Provider Name | Mr. Elliot Joseph Cruz |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | San Antonio, TX 78229-5640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 14/06/2021 |