Provider Demographics
NPI:1548937832
Name:CRUZ, JOAQUIN EMILIO (IDC)
Entity type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:EMILIO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26054 MANZANITA ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6317
Mailing Address - Country:US
Mailing Address - Phone:813-760-4431
Mailing Address - Fax:
Practice Address - Street 1:USS GEORGE WASHINGTON (CVN 73)
Practice Address - Street 2:CVN 73, UNIT 100148, 1
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09550
Practice Address - Country:US
Practice Address - Phone:757-534-3448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program