MEDICARE: RICHARD J CRUZ RN

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	700020	CA

General Provider Information

NPI Number	:	1174742373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J CRUZ RN

Provider Business Mailing Address
First Line	:	324 TREEWOOD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-4330
Country	:	US
Telephone Number	:	619-266-1638
Fax Number	:

Provider Business Practice Location Address
First Line	:	3853 ROSECRANS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3115
Country	:	US
Telephone Number	:	619-692-8227
Fax Number	:

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	05/10/2026

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