Provider Demographics
NPI:1619090560
Name:CRUZ, ROSIEMARIE MATILDE (DDS)
Entity Type:Individual
Prefix:
First Name:ROSIEMARIE
Middle Name:MATILDE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 E 2ND ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3959
Mailing Address - Country:US
Mailing Address - Phone:562-433-1232
Mailing Address - Fax:562-433-1618
Practice Address - Street 1:5580 E 2ND ST STE 204
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3959
Practice Address - Country:US
Practice Address - Phone:562-433-1232
Practice Address - Fax:562-433-1618
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist