Healthcare Provider Details

I. General information

NPI: 1710320536
Provider Name (Legal Business Name): CORNELIA RUIZ DANGLA CRUZ RNC, MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NORTH RENO ST. QUEENSCARE HEALTH CENTER
LOS ANGELES CA
90026
US

IV. Provider business mailing address

950 S GRAND AVE FL 2
LOS ANGELES CA
90015-3999
US

V. Phone/Fax

Practice location:
  • Phone: 213-380-7298
  • Fax:
Mailing address:
  • Phone: 323-669-4346
  • Fax: 323-635-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: