Healthcare Provider Details

I. General information

NPI: 1225115389
Provider Name (Legal Business Name): JAMES EDWARD CRUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CITADEL DRIVE SUITE 490
LOS ANGELES CA
90040
US

IV. Provider business mailing address

217 W. AVENIDA VALENCIA
SAN CLEMENTE CA
92672
US

V. Phone/Fax

Practice location:
  • Phone: 323-889-7388
  • Fax: 323-889-7399
Mailing address:
  • Phone: 949-842-4597
  • Fax: 949-218-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG064975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: