Basic Information
| Provider Information | |||||||||
| NPI: | 1811076821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 PENSACOLA ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968142118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084322000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1010 PENSACOLA ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968142118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084322000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN-134 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 54979302 | 05 | HI | MEDICAID | 0000220152 | 01 | HI | HMSA BILLING NUMBER | OTHER |