Provider Demographics
NPI:1366266538
Name:CRUZ, JEZREEL (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JEZREEL
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12332 HEARTSTONE CIR APT A
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-6658
Mailing Address - Country:US
Mailing Address - Phone:661-303-5782
Mailing Address - Fax:
Practice Address - Street 1:12332 HEARTSTONE CIR APT A
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-6658
Practice Address - Country:US
Practice Address - Phone:661-303-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2024072993363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology