MEDICARE: DR. ERICKSON CRUZ BAUTISTA D.N.P

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	363LG0600X	Gerontology Nurse Practitioner	95002040	CA
2	163WG0600X	Gerontology Registered Nurse	822775	NV
3	363L00000X	Nurse Practitioner	95002040	CA
4	363LA2200X	Adult Health Nurse Practitioner	822775	NV
5	363LG0600X	Gerontology Nurse Practitioner	822775	NV
6	363LA2200X	Adult Health Nurse Practitioner	95002040	CA
7	163W00000X	Registered Nurse	715867	CA

General Provider Information

NPI Number	:	1285024083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICKSON CRUZ BAUTISTA D.N.P

Provider Business Mailing Address
First Line	:	18411 CRENSHAW BLVD STE 110
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5078
Country	:	US
Telephone Number	:	310-817-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	6926 BROCKTON AVE STE 8
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3804
Country	:	US
Telephone Number	:	877-414-7739
Fax Number	:

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

Provider Enumeration Date	:	01/31/2015
Last Update Date	:	05/17/2023

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Directions to “ DR. ERICKSON CRUZ BAUTISTA D.N.P” Practice Location

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