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NPI Code Detail

MEDICARE: DAVID IVAN CRUZ

MEDICARE:   DAVID IVAN 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
1390200000XStudent in an Organized Health Care Education/Training ProgramCA
2225400000XRehabilitation Practitioner
3225400000XRehabilitation PractitionerCA

General Provider Information

NPI Number : 1831955707
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID IVAN CRUZ
Provider Business Mailing Address
First Line : 499 LOMA ALTA AVE
Second Line :
City : LOS GATOS
State : CA
Zip : 95030-6227
Country : US
Telephone Number : 408-379-3790
Fax Number :
Provider Business Practice Location Address
First Line : 8945 GOLF LINKS RD
Second Line :
City : OAKLAND
State : CA
Zip : 94605-4124
Country : US
Telephone Number : 510-317-1444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2024
Last Update Date : 06/16/2026

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