Provider Demographics
NPI:1679191951
Name:CONCEPCION, CHERILOU CRUZ (NP)
Entity Type:Individual
Prefix:
First Name:CHERILOU
Middle Name:CRUZ
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3333 CONCOURS ST, BUILDING 1
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-6806
Mailing Address - Country:US
Mailing Address - Phone:909-476-4077
Mailing Address - Fax:
Practice Address - Street 1:3333 CONCOURS ST
Practice Address - Street 2:BUILDING 1, SUITE 1201
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-9176
Practice Address - Country:US
Practice Address - Phone:909-476-4077
Practice Address - Fax:909-476-4088
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95014780207N00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207N00000XAllopathic & Osteopathic PhysiciansDermatology