Provider Demographics
NPI:1053891648
Name:CRUZ MARQUEZ, BERENICE
Entity type:Individual
Prefix:
First Name:BERENICE
Middle Name:
Last Name:CRUZ MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4101
Mailing Address - Country:US
Mailing Address - Phone:956-507-0377
Mailing Address - Fax:956-992-1090
Practice Address - Street 1:4014 N 22ND ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4101
Practice Address - Country:US
Practice Address - Phone:956-507-0377
Practice Address - Fax:956-992-1090
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79903101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health