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General NPI Number Information
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NPI Number | 1598233629
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Entity Type | Individual
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Provider Name | JEROMY CRUZ ASIDO PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 550 N FLOWER ST
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City | SANTA ANA
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State | CA
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Zip | 92703-2361
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Country | US
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Telephone | 714-647-6017
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Fax |
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Provider Business Mailing Address
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Address Line | 13174 58TH ST
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City | EASTVALE
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State | CA
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Zip | 92880-4601
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Country | US
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Telephone | 714-260-1215
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95009315
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License Number State | CA
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