Healthcare Provider Details

I. General information

NPI: 1639985930
Provider Name (Legal Business Name): VIVIANA YADIRA CRUZ-GARCIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2400
US

IV. Provider business mailing address

3318 FITHIAN AVE
LOS ANGELES CA
90032-1911
US

V. Phone/Fax

Practice location:
  • Phone: 323-859-3634
  • Fax: 323-987-1212
Mailing address:
  • Phone: 323-916-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW121916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: