Individual
MRS. LISSETTE I CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
64 BLACK ROCK AVE, BRIDGEPORT, CT 06605-1200
(203) 579-5000
(203) 579-5113
Mailing address
259 LIGHT ST, STRATFORD, CT 06614-5233
(203) 583-5976
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003107
CT
Other
Enumeration date
07/21/2014
Last updated
04/20/2015
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