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Organization
ILDEFONSO CRUZ M D A PROFESSIONAL CORP
Active
Organization
ILDEFONSO CRUZ M D A PROFESSIONAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILDEFONSO CRUZ M.D. (PRESIDENT)
(559) 449-7300
Entity
Organization
Contact information
Practice address
1646 E HERNDON AVE STE 102, FRESNO, CA 93720-3380
(559) 449-7300
(559) 449-7311
Mailing address
1646 E HERNDON AVE STE 102, FRESNO, CA 93720-3380
(559) 449-7300
(559) 449-7311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G28469
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G284690
—
CA
01
—
05D0589791
CLIA
—
01
—
G28469
MEDICAL LICENSE
CA
Enumeration date
11/10/2010
Last updated
02/23/2024
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