MEDICARE: ROSIEMARIE MATILDE CRUZ DDS

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	:	1619090560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSIEMARIE MATILDE CRUZ DDS

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	07/08/2007

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