Provider Demographics
NPI:1457363004
Name:CRUZ, ALICE C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:C
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 54679
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0679
Mailing Address - Country:US
Mailing Address - Phone:310-967-1884
Mailing Address - Fax:310-967-1744
Practice Address - Street 1:8767 WILSHIRE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2714
Practice Address - Country:US
Practice Address - Phone:310-248-7006
Practice Address - Fax:424-314-8735
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-04-06
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Provider Licenses
StateLicense IDTaxonomies
CAA67443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH22571Medicare UPIN