Healthcare Provider Details

I. General information

NPI: 1558513820
Provider Name (Legal Business Name): BELLE STARR CRUZ PHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 FOOTHILL BLVD
LA CANADA CA
91011-3507
US

IV. Provider business mailing address

523 FOOTHILL BLVD
LA CANADA CA
91011-3507
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-1802
  • Fax: 818-790-1332
Mailing address:
  • Phone: 818-790-1802
  • Fax: 818-790-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number54211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: