Provider Demographics
NPI:1619066651
Name:RIVERA-CRUZ, BERENICE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:BERENICE
Middle Name:
Last Name:RIVERA-CRUZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10153 BROMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352-1147
Mailing Address - Country:US
Mailing Address - Phone:818-602-8398
Mailing Address - Fax:818-767-1739
Practice Address - Street 1:1830 FLOWER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4144
Practice Address - Country:US
Practice Address - Phone:661-326-2000
Practice Address - Fax:661-326-2000
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512998367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN5129980Medicaid
CAZZZ05745ZMedicare PIN