Healthcare Provider Details

I. General information

NPI: 1477012581
Provider Name (Legal Business Name): NAYELI Z CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 RICHLAND AVE STE C
CERES CA
95307-4562
US

IV. Provider business mailing address

1904 RICHLAND AVE STE C
CERES CA
95307-4562
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-5079
  • Fax:
Mailing address:
  • Phone: 209-525-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129937
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: