Provider Demographics
NPI:1891272951
Name:CRUZADO, RUPEBETH REBONG (RDA)
Entity Type:Individual
Prefix:MRS
First Name:RUPEBETH
Middle Name:REBONG
Last Name:CRUZADO
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E CARSON ST UNIT 98
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2726
Mailing Address - Country:US
Mailing Address - Phone:310-755-4810
Mailing Address - Fax:
Practice Address - Street 1:1730 SEPULVEDA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-6901
Practice Address - Country:US
Practice Address - Phone:310-341-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA80231126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant