Healthcare Provider Details

I. General information

NPI: 1033270400
Provider Name (Legal Business Name): JOCELYN AQUINO CRUZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOCELYN AQUINO-CRUZ MD

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

IV. Provider business mailing address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2080
  • Fax: 707-425-4014
Mailing address:
  • Phone: 707-784-2080
  • Fax: 707-425-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA74774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: