Healthcare Provider Details

I. General information

NPI: 1023243524
Provider Name (Legal Business Name): MARJU S CRUZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 N VERMONT AVE
LOS ANGELES CA
90027-5312
US

IV. Provider business mailing address

1637 N VERMONT AVE
LOS ANGELES CA
90027-5312
US

V. Phone/Fax

Practice location:
  • Phone: 323-664-9854
  • Fax: 323-664-0512
Mailing address:
  • Phone: 323-664-9854
  • Fax: 323-664-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH60902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: