Provider Demographics
NPI:1124001888
Name:CRUZ, ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 PLUM LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4596
Mailing Address - Country:US
Mailing Address - Phone:909-475-5800
Mailing Address - Fax:909-475-5805
Practice Address - Street 1:1684 PLUM LN
Practice Address - Street 2:SUITE 101
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4596
Practice Address - Country:US
Practice Address - Phone:909-475-5800
Practice Address - Fax:909-475-5805
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49014208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0051840Medicaid
F23439Medicare UPIN