Provider Demographics
NPI:1801776950
Name:CRUZ VERGARA, EDUARDO J
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:J
Last Name:CRUZ VERGARA
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 1:201 ENTERPRISE AVE # 400B
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3082
Mailing Address - Country:US
Mailing Address - Phone:713-352-1951
Mailing Address - Fax:
Practice Address - Street 1:201 ENTERPRISE AVE # 400B
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3082
Practice Address - Country:US
Practice Address - Phone:713-352-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor