Healthcare Provider Details

I. General information

NPI: 1114229762
Provider Name (Legal Business Name): LUCITA M CRUZ MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12507 ALONDRA BLVD
NORWALK CA
90650-7351
US

IV. Provider business mailing address

12507 ALONDRA BLVD
NORWALK CA
90650-7351
US

V. Phone/Fax

Practice location:
  • Phone: 562-802-2203
  • Fax: 562-404-8555
Mailing address:
  • Phone: 562-802-2203
  • Fax: 562-404-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA37419
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA37419
License Number StateCA

VIII. Authorized Official

Name: LUCITA CRUZ
Title or Position: OWNER
Credential: MD
Phone: 562-802-2203