1710126875 NPI number — DR. JORGE ALBERTO CRUZ SR. DDS

Table of content: DR. JORGE ALBERTO CRUZ SR. DDS (NPI 1710126875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710126875 NPI number — DR. JORGE ALBERTO CRUZ SR. DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUZ
Provider First Name:
JORGE
Provider Middle Name:
ALBERTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1710126875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEBER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92249-0630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-852-3262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE B 230 ENTRE SEGUNDA Y SARATOGA
Provider Second Line Business Practice Location Address:
COLONIA CENTRO
Provider Business Practice Location Address City Name:
LOS ALGODONES
Provider Business Practice Location Address State Name:
BAJA CALIFORNIA
Provider Business Practice Location Address Postal Code:
21970
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
658-517-3262
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2009

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: 1223G0001X , with the licence number:  4829201 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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