Provider Demographics
NPI:1023103900
Name:CRUZ, LETICIA H (PA-C)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:H
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11452 SPACE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3599
Mailing Address - Country:US
Mailing Address - Phone:713-486-6200
Mailing Address - Fax:713-844-2470
Practice Address - Street 1:11452 SPACE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-3599
Practice Address - Country:US
Practice Address - Phone:713-486-6200
Practice Address - Fax:713-844-2470
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03609363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03609OtherLICENSE