Provider Demographics
NPI:1548955081
Name:CRUZ AMAYA, SUSANA P
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:P
Last Name:CRUZ AMAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18457 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-4660
Mailing Address - Country:US
Mailing Address - Phone:253-287-2373
Mailing Address - Fax:
Practice Address - Street 1:18457 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-4660
Practice Address - Country:US
Practice Address - Phone:253-287-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL1Z8PJ663B106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician