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Organization
LITTLE ANGELS
Active
Organization
LITTLE ANGELS
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA RENEA CRUZ RN (OWNER)
(208) 313-0711
Entity
Organization
Contact information
Practice address
1680 WOODRUFF PARK, IDAHO FALLS, ID 83401-3330
(208) 313-0711
Mailing address
1680 WOODRUFF PARK, IDAHO FALLS, ID 83401-3330
(208) 313-0711
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
M-9188
ID
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
363A00000X
Physician Assistant
PA-334
ID
Other
Enumeration date
05/08/2012
Last updated
02/01/2013
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