MEDICARE: MR. HENRY CRUZ PT

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	225100000X	Physical Therapist	22061	CA

General Provider Information

NPI Number	:	1649493800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HENRY CRUZ PT

Provider Business Mailing Address
First Line	:	400 PASEO CAMARILLO
Second Line	:	APT 316
City	:	CAMARILLO
State	:	CA
Zip	:	93010-5983
Country	:	US
Telephone Number	:	805-383-4050
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 HODENCAMP RD
Second Line	:	SUITE #100
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5810
Country	:	US
Telephone Number	:	805-449-3489
Fax Number	:

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	11/30/2021

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