Provider Demographics
NPI:1700761673
Name:GOMEZ-CRUZ, ITZEL GUADALUPE
Entity type:Individual
Prefix:
First Name:ITZEL
Middle Name:GUADALUPE
Last Name:GOMEZ-CRUZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S ST LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-4320
Mailing Address - Country:US
Mailing Address - Phone:213-480-1557
Mailing Address - Fax:
Practice Address - Street 1:560 S ST LOUIS ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4320
Practice Address - Country:US
Practice Address - Phone:213-480-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program