Healthcare Provider Details

I. General information

NPI: 1962318139
Provider Name (Legal Business Name): EMMELIN CRUZ LEPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13132 NEWPORT AVE STE 210
TUSTIN CA
92780-3429
US

IV. Provider business mailing address

3063 W CHAPMAN AVE APT 2224
ORANGE CA
92868-1746
US

V. Phone/Fax

Practice location:
  • Phone: 714-450-2263
  • Fax:
Mailing address:
  • Phone: 714-234-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95467376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: