Provider Demographics
NPI:1548050602
Name:CRUZ, JEFFREY
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 S MAIN ST APT 511
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3292
Mailing Address - Country:US
Mailing Address - Phone:310-408-2321
Mailing Address - Fax:
Practice Address - Street 1:1280 E CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-3292
Practice Address - Country:US
Practice Address - Phone:989-774-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program