Healthcare Provider Details

I. General information

NPI: 1962367060
Provider Name (Legal Business Name): JASMINE FLOWERS CRUZ MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12984 HESPERIA RD STE 101
VICTORVILLE CA
92395-5819
US

IV. Provider business mailing address

9183 SVL BOX
VICTORVILLE CA
92395-5135
US

V. Phone/Fax

Practice location:
  • Phone: 562-416-5401
  • Fax:
Mailing address:
  • Phone: 562-416-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: