Healthcare Provider Details

I. General information

NPI: 1730846452
Provider Name (Legal Business Name): YERALDY CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 W 101ST ST
LOS ANGELES CA
90044-3101
US

IV. Provider business mailing address

1057 W 101ST ST
LOS ANGELES CA
90044-3101
US

V. Phone/Fax

Practice location:
  • Phone: 424-386-6815
  • Fax:
Mailing address:
  • Phone: 424-386-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: