Basic Information
| Provider Information | |||||||||
| NPI: | 1922326495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 DWIGHT WAY | ||||||||
| Address2: | SUITE 4190 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947042608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108432220 | ||||||||
| FaxNumber: | 5102043060 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 DWIGHT WAY | ||||||||
| Address2: | SUITE 4190 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947042608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102044635 | ||||||||
| FaxNumber: | 5102043060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2010 | ||||||||
| LastUpdateDate: | 10/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 136920 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | 136920 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.