Provider Demographics
NPI:1073107538
Name:CRUZ, ANGELINA
Entity Type:Individual
Prefix:MS
First Name:ANGELINA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:1IDEALTRANSPORTATION
Mailing Address - Street 1:2339 E FLORA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-4334
Mailing Address - Country:US
Mailing Address - Phone:209-507-5999
Mailing Address - Fax:
Practice Address - Street 1:2339 E FLORA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-4334
Practice Address - Country:US
Practice Address - Phone:209-507-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD9550733343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86-1725607OtherNON EMERGENCY TRANSPORTATION