Provider Demographics
NPI:1326704172
Name:CRUZ RODRIGUEZ, EVELYN CAROLINA
Entity Type:Individual
Prefix:MISS
First Name:EVELYN
Middle Name:CAROLINA
Last Name:CRUZ RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:EVELYN
Other - Middle Name:CAROLINA
Other - Last Name:CRUZ RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1380 CALLE GOMERO
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6626
Mailing Address - Country:US
Mailing Address - Phone:805-405-9402
Mailing Address - Fax:
Practice Address - Street 1:3825 E THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3639
Practice Address - Country:US
Practice Address - Phone:805-497-3614
Practice Address - Fax:805-497-0524
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA165441183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician