Provider Demographics
NPI:1447945852
Name:CRUZ OCANA, LEIDI LUCINDA
Entity type:Individual
Prefix:
First Name:LEIDI
Middle Name:LUCINDA
Last Name:CRUZ OCANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-4478
Mailing Address - Country:US
Mailing Address - Phone:951-849-8614
Mailing Address - Fax:
Practice Address - Street 1:806 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-4478
Practice Address - Country:US
Practice Address - Phone:951-849-8614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115261183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician