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General NPI Number Information
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NPI Number | 1437604600
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Entity Type | Organization
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Legal Business Name | CESAR CRUZ, M.D. A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 1161 E COVINA BLVD
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City | COVINA
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State | CA
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Zip | 91724-1523
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Country | US
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Telephone | 909-279-1740
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1770
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City | LA MESA
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State | CA
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Zip | 91944-1770
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Country | US
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Telephone | 619-464-1165
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Fax | 619-567-1011
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Authorized Official
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Title or Position | OWNER
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Name | CESAR CRUZ
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Credential | M.D.
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Telephone | 909-279-1740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A120136
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License Number State | CA
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