Provider Demographics
NPI:1699403253
Name:CRUZ, ZACHARY ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ANDREW
Last Name:CRUZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18725 CAMINITO CANTILENA APT 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6149
Mailing Address - Country:US
Mailing Address - Phone:209-352-4723
Mailing Address - Fax:
Practice Address - Street 1:29115 VALLEY CENTER RD STE E
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6553
Practice Address - Country:US
Practice Address - Phone:760-751-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist