Provider Demographics
NPI:1548500291
Name:CRUZ, TEOFILA MARIA PEREZ (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:TEOFILA MARIA
Middle Name:PEREZ
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W SANTA MONICA AVE
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-5286
Mailing Address - Country:US
Mailing Address - Phone:671-635-7492
Mailing Address - Fax:
Practice Address - Street 1:520 W SANTA MONICA AVE
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5286
Practice Address - Country:US
Practice Address - Phone:671-635-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21660363L00000X
GUNP0118363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner