| Ildefonso Cruz Md Medical Corporation | |
|
1646 E Herndon Ave Ste 102 Fresno CA 93720-3380 | |
| (559) 449-7300 | |
| (559) 449-7311 |
| Full Name | Ildefonso Cruz Md Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 1646 E Herndon Ave Ste 102, Fresno, California |
| Authorized Official Name and Position | Ildefonso Cruz (PRESIDENT) |
| Authorized Official Contact | 5594497300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ildefonso Cruz Md Medical Corporation 1646 E Herndon Ave Ste 102 Fresno CA 93720-3380 Ph: (559) 449-7300 | Ildefonso Cruz Md Medical Corporation 1646 E Herndon Ave Ste 102 Fresno CA 93720-3380 Ph: (559) 449-7300 |
| NPI Number | 1083916316 |
|---|---|
| Provider Enumeration Date | 11/18/2010 |
| Last Update Date | 02/23/2024 |
| Medicare PECOS PAC ID | 5597992511 |
|---|---|
| Medicare Enrollment ID | O20131219001597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083916316 | NPI | - | NPPES |
| 05D0589791 | Other | CLIA | |
| 00G284690 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G28469 (California) | Primary |
| Provider Name | Ildefonso Cruz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275689085 PECOS PAC ID: 3274728159 Enrollment ID: I20101117001167 |
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