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General NPI Number Information
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NPI Number | 1891081089
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Entity Type | Individual
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Provider Name | KIMBERLY LYNN CRUZ RDHAP
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Gender | Female
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Dates
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Enumeration Date | 06/26/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 12562 DALE ST UNIT 30
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4565
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Country | US
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Telephone | 714-583-8165
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Fax |
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Provider Business Mailing Address
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Address Line | 9877 CHAPMAN AVE STE. D #413
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4565
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Country | US
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Telephone | 714-638-8709
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Fax | 714-638-8917
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | RDHAP#354
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License Number State | CA
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