Active NPI
Jenna Jade Cruz, LM,CPM,BSM
- Midwife
- West Covina, CA
National Provider Identifier
1114707858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- 718
- Practice address
- 1621 S Siesta Ave
West Covina, CA 91790-5620 - Phone
- (626) 364-2720
- NPI assigned
- Oct 2, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | 718 | CA | Primary |
Addresses
Primary practice location
1621 S Siesta Ave
West Covina, CA 91790-5620
Mailing address
1621 S Siesta Ave
West Covina, CA 91790-5620
Phone (626) 488-9777
Other names 1
- Jenna Jade Gallegos
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696204800000",
"number": "1114707858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 S SIESTA AVE",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917905620",
"telephone_number": "626-488-9777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1621 S SIESTA AVE",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917905620",
"telephone_number": "626-364-2720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "JENNA",
"middle_name": "JADE",
"credential": "LM,CPM,BSM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-02",
"last_updated": "2023-10-02",
"certification_date": "2023-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "CA",
"license": "718",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNA",
"last_name": "GALLEGOS",
"middle_name": "JADE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.