Provider Demographics
NPI:1801112164
Name:CRUZ, SALVADOR (DA)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4609
Mailing Address - Country:US
Mailing Address - Phone:323-535-9191
Mailing Address - Fax:
Practice Address - Street 1:9910 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-1561
Practice Address - Country:US
Practice Address - Phone:323-563-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant