Healthcare Provider Details

I. General information

NPI: 1447885884
Provider Name (Legal Business Name): ZACHARY CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11007 FRINK RANCH RD
LOMA LINDA CA
92354-6130
US

IV. Provider business mailing address

11007 FRINK RANCH RD
LOMA LINDA CA
92354-6130
US

V. Phone/Fax

Practice location:
  • Phone: 909-831-5333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95041060
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95202606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: