MEDICARE: KARLA CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	174H00000X	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1023573482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA CRUZ

Provider Business Mailing Address
First Line	:	1680 W SHAW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3504
Country	:	US
Telephone Number	:	559-244-4572
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 W SHAW AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3504
Country	:	US
Telephone Number	:	559-244-4572
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2019
Last Update Date	:	02/09/2019

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Directions to “ KARLA CRUZ ” Practice Location

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