Basic Information
| Provider Information | |||||||||
| NPI: | 1366628034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ-GUILLEN | ||||||||
| FirstName: | YAMARI | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN-BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 528 MURIEL PKWY | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 072081605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084690561 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 151 KNOLLCROFT RD | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079395001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2008 | ||||||||
| LastUpdateDate: | 01/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 028626 | PR | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.