Provider Demographics
NPI:1316067622
Name:NEPOMUCENO, CARLOTA CRUZ (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOTA
Middle Name:CRUZ
Last Name:NEPOMUCENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0848
Mailing Address - Country:US
Mailing Address - Phone:530-226-1721
Mailing Address - Fax:530-224-2742
Practice Address - Street 1:1441 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0848
Practice Address - Country:US
Practice Address - Phone:530-226-1721
Practice Address - Fax:530-224-2742
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094270Medicaid
CAG16658Medicare UPIN
CAZZZ28412ZMedicare ID - Type UnspecifiedMEDICARE