Provider Demographics
NPI:1982793527
Name:CRUZ, AIDA DEVERA (MD)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:DEVERA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E HILL STREET
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3682
Mailing Address - Country:US
Mailing Address - Phone:562-424-6200
Mailing Address - Fax:562-427-4634
Practice Address - Street 1:1814 W LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6730
Practice Address - Country:US
Practice Address - Phone:714-780-5690
Practice Address - Fax:714-780-5696
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48941207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489410Medicaid
WA48941BMedicare ID - Type Unspecified
CA00A489410Medicaid