Healthcare Provider Details

I. General information

NPI: 1447385190
Provider Name (Legal Business Name): CORNELIUS CUZA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 S 4TH ST
EL CENTRO CA
92243-6012
US

IV. Provider business mailing address

107 S 5TH ST STE 222
EL CENTRO CA
92243-3028
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY6660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: