MEDICARE: ROSIEMARIE M CRUZ DDS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	36350	CA

General Provider Information

NPI Number	:	1396968335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSIEMARIE M CRUZ DDS INC.

Provider Business Mailing Address
First Line	:	5580 E 2ND ST STE 204
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3959
Country	:	US
Telephone Number	:	562-433-1232
Fax Number	:	562-433-1618

Provider Business Practice Location Address
First Line	:	5580 E 2ND ST STE 204
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3959
Country	:	US
Telephone Number	:	562-433-1232
Fax Number	:	562-433-1618

Authorized Official
Title or Position	:	PRINCIPAL STOCKHOLDER
Name	:	DR. ROSIEMARIE MATILDE CRUZ
Credential	:	DDS
Telephone Number	:	562-433-1232

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/03/2014

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