Healthcare Provider Details

I. General information

NPI: 1922911791
Provider Name (Legal Business Name): DANIEL CRUZ RDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90022-1209
US

IV. Provider business mailing address

5017 WHITTIER BLVD
LOS ANGELES CA
90022-3116
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-9191
  • Fax: 323-268-9191
Mailing address:
  • Phone: 323-268-9191
  • Fax: 323-268-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA107240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: