Basic Information
| Provider Information | |||||||||
| NPI: | 1770051153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | RHODORA | ||||||||
| MiddleName: | ROQUE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CRUZ | ||||||||
| OtherFirstName: | RHODORA | ||||||||
| OtherMiddleName: | ROQUE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1244 N MARINE CORPS DR | ||||||||
| Address2: | |||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969134308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6717770632 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1244 N MARINE CORPS DR | ||||||||
| Address2: | |||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969134308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716475252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2018 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | RX0440 | GU | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | NP0194 | GU | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.