Provider Demographics
NPI:1639435456
Name:CRUZ, DAVID DAN
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DAN
Last Name: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 1:8019 S. COMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001
Mailing Address - Country:US
Mailing Address - Phone:323-586-7333
Mailing Address - Fax:323-319-1979
Practice Address - Street 1:8019 S. COMPTON AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001
Practice Address - Country:US
Practice Address - Phone:323-586-7333
Practice Address - Fax:323-319-1979
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA786160364S00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist