Ildefonso Cruz M D a Professional Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G28469 Issued in CA

Legal business name

ILDEFONSO CRUZ M D A PROFESSIONAL CORP

Practice address

1646 E Herndon Ave Ste 102
Fresno, CA 93720-3380

Phone

(559) 449-7300

Fax

(559) 449-7311

NPI assigned

Nov 10, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ildefonso Cruz, M.D.

Title

President

Phone

(559) 449-7300

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1821399635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1646 E HERNDON AVE STE 102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203380",
            "telephone_number": "559-449-7300",
            "fax_number": "559-449-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1646 E HERNDON AVE STE 102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203380",
            "telephone_number": "559-449-7300",
            "fax_number": "559-449-7311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILDEFONSO CRUZ M D A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-10",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "ILDEFONSO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "559-449-7300",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G28469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0589791",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G284690",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "G28469",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adanna O Ikedilo, MD, FACOG
• Kenneth A Ikemiya, MD
• Farisa M Ikner
• Audra Lynn Iknoian, PHARMD
• Ikon Equity Solutions Cor
• Ildefonso Cruz MD Medical Corporation
• Daniel Edward Ildefonso, CADTP 22439
• Travis Iler
• Sergio Ilic
• Michael Illingworth, M.D.

• Family Medicine Physician in Fresno, CA
• Providers in Fresno, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.