Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LG50083671 | DC |
NPI | 1003480898 |
---|---|
Provider Name | Mr. Roberto Cruz |
First Address | Washington, DC 20020-7024 |
Second Address | Washington, DC 20020-7024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2021 |
Last Update Date | 17/05/2021 |