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General NPI Number Information
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NPI Number | 1477376309
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Entity Type | Individual
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Provider Name | JESSICA CRUZE FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 12954 HAWTHORNE BLVD STE 104
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City | HAWTHORNE
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State | CA
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Zip | 90250-4418
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Country | US
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Telephone | 310-679-0269
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 HARPER AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90278-2724
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Country | US
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Telephone | 805-813-1819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95032620
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License Number State | CA
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