Healthcare Provider Details

I. General information

NPI: 1720691413
Provider Name (Legal Business Name): MIGUEL A SANTIAGO CRUZ MSN, RN, PMHNP-BC,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 E CHEVY CHASE DR STE 130
GLENDALE CA
91206-4140
US

IV. Provider business mailing address

1560 E CHEVY CHASE DR STE 130
GLENDALE CA
91206-4140
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone: 858-279-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028856
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95178307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: