Provider Demographics
NPI:1801640321
Name:CRUZ, ROCHELL
Entity type:Individual
Prefix:
First Name:ROCHELL
Middle Name:
Last Name:CRUZ
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 1:87-2070 FARRINGTON HWY STE K
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3756
Mailing Address - Country:US
Mailing Address - Phone:808-861-1514
Mailing Address - Fax:
Practice Address - Street 1:87-2070 FARRINGTON HWY STE K
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3756
Practice Address - Country:US
Practice Address - Phone:808-861-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIIPHMNM12540175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI29-1299.01OtherNATRUOPATHIC
HI29-1299.01Medicaid