Provider Demographics
NPI:1992837652
Name:RODRIGUEZ CRUZ, ALBERTO
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:
Last Name:RODRIGUEZ CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79440 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7241
Mailing Address - Country:US
Mailing Address - Phone:760-564-7716
Mailing Address - Fax:760-564-8625
Practice Address - Street 1:79440 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7241
Practice Address - Country:US
Practice Address - Phone:760-564-7716
Practice Address - Fax:760-564-8625
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB 48006-01Medicaid
CAB48006-02Medicaid
CAB 48006-01Medicaid