Healthcare Provider Details

I. General information

NPI: 1073059069
Provider Name (Legal Business Name): ANDREA CRUZ LMFT 127961
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2160
BIG BEAR CITY CA
92314-2160
US

IV. Provider business mailing address

5628 E. SLAUSON AVE.
COMMERCE CA
90040
US

V. Phone/Fax

Practice location:
  • Phone: 562-225-1786
  • Fax:
Mailing address:
  • Phone: 323-318-9960
  • Fax: 323-780-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number127961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: