MEDICARE: DR. ROSEMARIE QUIMSON-CRUZ, DMD, INC.

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	305S00000X	Point of Service	44478	CA

General Provider Information

NPI Number	:	1366830473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ROSEMARIE QUIMSON-CRUZ, DMD, INC.

Provider Business Mailing Address
First Line	:	2252 BEVERLY BLVD
Second Line	:	SUITE 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2225
Country	:	US
Telephone Number	:	213-387-6453
Fax Number	:	213-387-5390

Provider Business Practice Location Address
First Line	:	2252 BEVERLY BLVD
Second Line	:	SUITE 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2225
Country	:	US
Telephone Number	:	213-387-6453
Fax Number	:	213-387-5390

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS DENNIS B CRUZ
Credential	:
Telephone Number	:	213-387-6453

Provider Enumeration Date	:	12/26/2014
Last Update Date	:	12/26/2014

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