Provider Demographics
NPI:1760292155
Name:LUMACTOD, JEANY DELA CRUZ (NP)
Entity type:Individual
Prefix:MRS
First Name:JEANY
Middle Name:DELA CRUZ
Last Name:LUMACTOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10563 JILL ST # A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4916
Mailing Address - Country:US
Mailing Address - Phone:714-271-6498
Mailing Address - Fax:
Practice Address - Street 1:1350 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2945
Practice Address - Country:US
Practice Address - Phone:310-634-7127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033517363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care