Provider Demographics
NPI:1841339355
Name:ALBERTO M. CRUZ, MD. INC.
Entity type:Organization
Organization Name:ALBERTO M. CRUZ, MD. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:MARCELINO
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-874-3490
Mailing Address - Street 1:195 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5165
Mailing Address - Country:US
Mailing Address - Phone:909-874-3490
Mailing Address - Fax:909-874-3470
Practice Address - Street 1:195 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5165
Practice Address - Country:US
Practice Address - Phone:909-874-3490
Practice Address - Fax:909-874-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53986208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539860Medicaid
G46425Medicare UPIN
CA00A539860Medicaid