Provider Demographics
NPI:1366830473
Name:DR. ROSEMARIE QUIMSON-CRUZ, DMD, INC.
Entity Type:Organization
Organization Name:DR. ROSEMARIE QUIMSON-CRUZ, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-387-6453
Mailing Address - Street 1:2252 BEVERLY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2225
Mailing Address - Country:US
Mailing Address - Phone:213-387-6453
Mailing Address - Fax:213-387-5390
Practice Address - Street 1:2252 BEVERLY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2225
Practice Address - Country:US
Practice Address - Phone:213-387-6453
Practice Address - Fax:213-387-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44478305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service