Healthcare Provider Details

I. General information

NPI: 1962770875
Provider Name (Legal Business Name): PATRICIA CRUZ REYES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA ALMARIO CRUZ MD

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79440 CORPORATE CENTER DR STE 108
LA QUINTA CA
92253-7243
US

IV. Provider business mailing address

79440 CORPORATE CENTER DR STE 108
LA QUINTA CA
92253-7243
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-0902
  • Fax: 760-406-6039
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA123452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: