Edward E Cruz, ARF CERTIFIED

Individual provider Active NPI Nursing Home Administrator · Artesia, CA

NPI 1093587644 · NPPES record last updated Oct 26, 2023

Key facts

NPI
1093587644
Entity type
Individual (NPI type 1)
Primary specialty
Nursing Home Administrator 376G00000X
License
6044600735 (CA)
Practice address
11954 166TH St
Artesia, CA 90701-1816
Phone
(714) 659-9152
NPI assigned
Oct 26, 2023
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
6044600735CAMDNursing Home Administrator

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Home Administrator 376G00000X 6044600735 CA Yes

Addresses

Primary practice location

11954 166TH St
Artesia, CA 90701-1816

Mailing address

11954 166TH St
Artesia, CA 90701-1816
Phone (714) 659-9152

Other providers in Artesia, CA

All providers in Artesia, CA · Nursing Home Administrator in California

Sources for this page

Verify at the official NPI Registry.