Provider Demographics
NPI:1033664586
Name:LOPEZ-CRUZ, EMMAUEL
Entity Type:Individual
Prefix:
First Name:EMMAUEL
Middle Name:
Last Name:LOPEZ-CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2320
Mailing Address - Country:US
Mailing Address - Phone:510-535-8400
Mailing Address - Fax:510-535-8484
Practice Address - Street 1:1415 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2320
Practice Address - Country:US
Practice Address - Phone:510-535-8400
Practice Address - Fax:510-535-8484
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker