Provider Demographics
NPI:1285984682
Name:CRUZ, ALMA DELIA
Entity type:Individual
Prefix:MS
First Name:ALMA
Middle Name:DELIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:6112 ALLSTON ST
Mailing Address - Street 2:P.O BOX 227437
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-4406
Mailing Address - Country:US
Mailing Address - Phone:213-858-2500
Mailing Address - Fax:
Practice Address - Street 1:6112 ALLSTON ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4406
Practice Address - Country:US
Practice Address - Phone:213-858-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0889239343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA343900000XMedicare PIN