MEDICARE: MARISSA CRUZADA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1407171143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA CRUZADA

Provider Business Mailing Address
First Line	:	3600 POWER INN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-3826
Country	:	US
Telephone Number	:	916-453-2704
Fax Number	:	916-453-2708

Provider Business Practice Location Address
First Line	:	3600 POWER INN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-3826
Country	:	US
Telephone Number	:	916-453-2704
Fax Number	:	916-453-2708

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

Provider Enumeration Date	:	04/06/2010
Last Update Date	:	04/06/2010

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Directions to “ MARISSA CRUZADA ” Practice Location

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