Healthcare Provider Details

I. General information

NPI: 1275653677
Provider Name (Legal Business Name): JAMIE LEE CRUZ MOTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28786 GREENWOOD PL
CASTAIC CA
91384-4321
US

IV. Provider business mailing address

28786 GREENWOOD PL
CASTAIC CA
91384-4321
US

V. Phone/Fax

Practice location:
  • Phone: 661-600-8809
  • Fax:
Mailing address:
  • Phone: 661-600-8809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT. 006856
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number9461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: