Provider Demographics
NPI:1598068868
Name:FIDEL SANTA-CRUZ M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FIDEL SANTA-CRUZ M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTA-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:323-588-3125
Mailing Address - Street 1:3100 E FLORENCE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5848
Mailing Address - Country:US
Mailing Address - Phone:323-588-3125
Mailing Address - Fax:323-588-0919
Practice Address - Street 1:3100 E FLORENCE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5848
Practice Address - Country:US
Practice Address - Phone:323-588-3125
Practice Address - Fax:323-588-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty