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General NPI Number Information
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NPI Number | 1396416152
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Entity Type | Organization
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Legal Business Name | CRUZMEDMO
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 325 SOQUEL AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95062-2305
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Country | US
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Telephone | 831-239-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 211 LADERA CT
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City | SANTA CRUZ
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State | CA
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Zip | 95060-5209
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Country | US
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Telephone | 831-239-4331
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW HAMILTON LEWIS
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Credential | DO
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Telephone | 831-239-4331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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