Active NPI
Jared Edan Cruz
- Pharmacist
- Willits, CA
National Provider Identifier
1740758036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 79581
- Practice address
- 3 Marcela Dr Ste B
Willits, CA 95490-5769 - Phone
- (707) 456-3005
- NPI assigned
- Nov 5, 2018
- Last updated
- Nov 5, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 79581 | CA | Primary |
Addresses
Primary practice location
3 Marcela Dr Ste B
Willits, CA 95490-5769
Mailing address
3 Marcela Dr Ste B
Willits, CA 95490-5769
Other names 1
- Jared-Edan Dumalaog Cruz
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79581 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ukiah Adventist Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Adventist Health Howard Pharmacy
- Community/Retail Pharmacy
- Willits, CA
- NPI 1629432968
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1541376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541376000000",
"number": "1740758036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 MARCELA DR STE B",
"city": "WILLITS",
"state": "CA",
"postal_code": "954905769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 MARCELA DR STE B",
"city": "WILLITS",
"state": "CA",
"postal_code": "954905769",
"telephone_number": "707-456-3005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "JARED",
"middle_name": "EDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-05",
"last_updated": "2018-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "79581",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JARED-EDAN",
"last_name": "DUMALAOG CRUZ",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Willits, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.