Provider Demographics
NPI:1750917373
Name:CRUZ FLORES, WENDY YANETH
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:YANETH
Last Name:CRUZ FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14707 TITUS ST APT 7
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4712
Mailing Address - Country:US
Mailing Address - Phone:323-252-7564
Mailing Address - Fax:
Practice Address - Street 1:14707 TITUS ST APT 7
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4712
Practice Address - Country:US
Practice Address - Phone:323-252-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA90013126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant