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General NPI Number Information
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NPI Number | 1679926646
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Entity Type | Individual
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Provider Name | MICHELLE CRUZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 32245 MISSION TRL STE D4
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4528
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Country | US
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Telephone | 951-674-1561
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Fax | 951-674-5300
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Provider Business Mailing Address
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Address Line | PO BOX 32
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City | SAN LUIS REY
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State | CA
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Zip | 92068-0032
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Country | US
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Telephone | 562-826-8000
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33482
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License Number State | CA
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