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General NPI Number Information
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NPI Number | 1548937832
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Entity Type | Individual
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Provider Name | JOAQUIN EMILIO CRUZ IDC
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Gender | Male
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | USS GEORGE WASHINGTON (CVN 73) CVN 73, UNIT 100148, 1
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City | FPO
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State | AE
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Zip | 09550
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Country | US
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Telephone | 757-534-3448
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Fax |
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Provider Business Mailing Address
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Address Line | 26054 MANZANITA ST
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City | MURRIETA
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State | CA
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Zip | 92563-6317
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Country | US
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Telephone | 813-760-4431
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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