Provider Demographics
NPI:1538598065
Name:CRUZ, MARIA GUADALUPE (DNP, CNM)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:GUADALUPE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 S 500 E STE 207
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1065
Mailing Address - Country:US
Mailing Address - Phone:801-560-0930
Mailing Address - Fax:801-531-0930
Practice Address - Street 1:34 S 500 E STE 207
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1065
Practice Address - Country:US
Practice Address - Phone:801-560-0930
Practice Address - Fax:801-531-0930
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT200580-3102163W00000X
UT200580-4405363L00000X
UT200580-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1538598065OtherNPI
UT1770060980OtherNPI2