Basic Information
| Provider Information | |||||||||
| NPI: | 1376021642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ-VENEGAS | ||||||||
| FirstName: | PAULINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 CHEROKEE ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300608930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787978201 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 660 CHEROKEE ST NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300608930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787978201 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2018 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 92449 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 21037 | PR | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.