1982734307 NPI number — MR. EUGENE REYES CRUZ LMP

Table of content: MR. EUGENE REYES CRUZ LMP (NPI 1982734307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982734307 NPI number — MR. EUGENE REYES CRUZ LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
EUGENE
Provider Middle Name:
REYES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982734307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15113 87TH AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98375-8415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-230-3659
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5800 SOUNDVIEW DR
Provider Second Line Business Practice Location Address:
SUITE C-101
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-858-4845
Provider Business Practice Location Address Fax Number:
253-857-8305
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA00016386 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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