Healthcare Provider Details

I. General information

NPI: 1245309202
Provider Name (Legal Business Name): MARIA E CRUZ B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

9432 MIKINDA AVE
LA HABRA CA
90631-2467
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0688
  • Fax: 562-402-3032
Mailing address:
  • Phone: 562-905-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: