Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95012718 | CA |
NPI | 1184273609 |
---|---|
Provider Name | John Conrad Cruz Uy |
First Address | South San Francisco, CA 94080-1454 |
Second Address | San Francisco, CA 94109-6919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 06/09/2019 |