MEDICARE: SONIA CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	0-17-7905	CA
2	103K00000X	Behavior Analyst	1-23-65462	CA

General Provider Information

NPI Number	:	1114437308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONIA CRUZ

Provider Business Mailing Address
First Line	:	2918 W 67TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-4440
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 E LAS TUNAS DR
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1404
Country	:	US
Telephone Number	:	626-320-1317
Fax Number	:	626-251-4266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	12/22/2023

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Directions to “ SONIA CRUZ ” Practice Location

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