Provider Demographics
NPI:1730565698
Name:DACRUZ, COLLETTE (RN, CDE)
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:
Last Name:DACRUZ
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:COLLETTE
Other - Middle Name:
Other - Last Name:DACRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CDE
Mailing Address - Street 1:1010 NUT TREE RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4172
Mailing Address - Country:US
Mailing Address - Phone:707-624-7999
Mailing Address - Fax:707-624-7998
Practice Address - Street 1:1010 NUT TREE RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4172
Practice Address - Country:US
Practice Address - Phone:707-624-7999
Practice Address - Fax:707-624-7998
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411404163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator