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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
363A00000X
Physician Assistant
PA-334
ID

Other

Enumeration date
05/08/2012
Last updated
02/01/2013
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