Provider Demographics
NPI:1699776211
Name:SUNDQUIST, CRUZ-ELENA (MD)
Entity type:Individual
Prefix:
First Name:CRUZ-ELENA
Middle Name:
Last Name:SUNDQUIST
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 1:420 W ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2943
Mailing Address - Country:US
Mailing Address - Phone:626-331-6411
Mailing Address - Fax:626-251-1560
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1905
Practice Address - Country:US
Practice Address - Phone:626-967-0559
Practice Address - Fax:626-966-0259
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54016Medicare UPIN