Healthcare Provider Details

I. General information

NPI: 1609770205
Provider Name (Legal Business Name): EDWIN CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 W 11TH ST
LOS ANGELES CA
90006-2755
US

IV. Provider business mailing address

10660 WHITE OAK AVE STE B101
GRANADA HILLS CA
91344-5943
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-0919
  • Fax:
Mailing address:
  • Phone: 818-834-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number59D91E10BD
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: