Provider Demographics
NPI:1821831538
Name:CRUZ, MICHELLE JEANNETTE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANNETTE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 STOCKTON CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6222
Mailing Address - Country:US
Mailing Address - Phone:951-446-6611
Mailing Address - Fax:
Practice Address - Street 1:12062 VALLEY VIEW ST STE 140
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1777
Practice Address - Country:US
Practice Address - Phone:657-356-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95029749363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care