Provider Demographics
NPI:1255808648
Name:A. RODRIGUEZ-CRUZ,DDS,INC.
Entity type:Organization
Organization Name:A. RODRIGUEZ-CRUZ,DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTELLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-825-2175
Mailing Address - Street 1:425 E ARROW HWY # 724
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5607
Mailing Address - Country:US
Mailing Address - Phone:909-825-2175
Mailing Address - Fax:909-825-0964
Practice Address - Street 1:827 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2001
Practice Address - Country:US
Practice Address - Phone:909-825-2175
Practice Address - Fax:909-825-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992837652Medicaid