Provider Demographics
NPI:1184176307
Name:CRUZ, IRENE ELIZABETH (NP-C)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:ELIZABETH
Last Name:CRUZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8241 ROCHESTER AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-989-2273
Mailing Address - Fax:
Practice Address - Street 1:8241 ROCHESTER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0700
Practice Address - Country:US
Practice Address - Phone:909-989-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily