Healthcare Provider Details

I. General information

NPI: 1861524159
Provider Name (Legal Business Name): ELSA CALUMPIT CRUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 HURLBUT
PASADENA CA
91105-3112
US

IV. Provider business mailing address

3755 DIVISION ST
LOS ANGELES CA
90065-4111
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4221
  • Fax: 626-799-1246
Mailing address:
  • Phone: 818-795-2515
  • Fax: 323-257-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA75757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: