Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1760851927 |
---|---|
Provider Name | Vanessa Cruz |
First Address | Pontiac, MI 48341-1515 |
Second Address | Pontiac, MI 48341-1515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2015 |
Last Update Date | 17/09/2015 |