Healthcare Provider Details

I. General information

NPI: 1386566958
Provider Name (Legal Business Name): SUSANA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MANCHESTER BLVD STE A
INGLEWOOD CA
90301-1196
US

IV. Provider business mailing address

405 W MANCHESTER BLVD STE A
INGLEWOOD CA
90301-1196
US

V. Phone/Fax

Practice location:
  • Phone: 310-672-3820
  • Fax:
Mailing address:
  • Phone: 310-672-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: