MEDICARE: DR. JOHN MICHAEL DE VERA CRUZ M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	136920	CA
2	2084P0800X	Psychiatry Physician	136920	CA

General Provider Information

NPI Number	:	1922326495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL DE VERA CRUZ M.D.

Provider Business Mailing Address
First Line	:	2001 DWIGHT WAY STE 4190
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-2608
Country	:	US
Telephone Number	:	510-843-2220
Fax Number	:	510-204-3060

Provider Business Practice Location Address
First Line	:	2001 DWIGHT WAY
Second Line	:	SUITE 4190
City	:	BERKELEY
State	:	CA
Zip	:	94704-2608
Country	:	US
Telephone Number	:	510-204-4635
Fax Number	:	510-204-3060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2010
Last Update Date	:	06/01/2026

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