Healthcare Provider Details

I. General information

NPI: 1780288431
Provider Name (Legal Business Name): LUIS ROBINSON ANG CRUZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 03/29/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE H-200
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

633 ASCOT DR APT 67
VISTA CA
92083-4218
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-3578
  • Fax: 760-725-0231
Mailing address:
  • Phone: 951-764-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20592
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: