Individual
EPHRAIM CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8027 CAMELLIA RD, NORFOLK, VA 23518-3416
(757) 227-1105
(757) 214-6634
Mailing address
8027 CAMELLIA RD, NORFOLK, VA 23518-3416
(757) 227-1105
(757) 214-6634
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
29911
VA
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81-3347603
—
VA
Enumeration date
08/10/2020
Last updated
08/10/2020
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