Provider Demographics
NPI:1922326495
Name:CRUZ, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2001 DWIGHT WAY
Mailing Address - Street 2:SUITE 4190
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2608
Mailing Address - Country:US
Mailing Address - Phone:510-843-2220
Mailing Address - Fax:510-204-3060
Practice Address - Street 1:2001 DWIGHT WAY
Practice Address - Street 2:SUITE 4190
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2608
Practice Address - Country:US
Practice Address - Phone:510-204-4635
Practice Address - Fax:510-204-3060
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-09
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1369202084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry