Provider Demographics
NPI:1487763652
Name:CRUZ, ALBERTO MARCELINO (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:MARCELINO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALBERTO
Other - Middle Name:M
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:195 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5165
Mailing Address - Country:US
Mailing Address - Phone:909-874-3490
Mailing Address - Fax:909-874-3470
Practice Address - Street 1:195 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5165
Practice Address - Country:US
Practice Address - Phone:909-874-3490
Practice Address - Fax:909-874-3470
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53986208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539860Medicaid
CA00A539860Medicaid