1679191951 NPI number — CHERILOU CRUZ CONCEPCION NP

Table of content: CHERILOU CRUZ CONCEPCION NP (NPI 1679191951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679191951 NPI number — CHERILOU CRUZ CONCEPCION NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONCEPCION
Provider First Name:
CHERILOU
Provider Middle Name:
CRUZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679191951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 CONCOURS ST, BUILDING 1
Provider Second Line Business Mailing Address:
SUITE 1201
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91764-6806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-476-4077
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 CONCOURS ST
Provider Second Line Business Practice Location Address:
BUILDING 1, SUITE 1201
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91764-9176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-476-4077
Provider Business Practice Location Address Fax Number:
909-476-4088
Provider Enumeration Date:
07/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  95014780 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 95014780 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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