Healthcare Provider Details

I. General information

NPI: 1215330287
Provider Name (Legal Business Name): MARICRUZ VACA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18217 HALE AVE
MORGAN HILL CA
95037-3550
US

IV. Provider business mailing address

18217 HALE AVE
MORGAN HILL CA
95037-3550
US

V. Phone/Fax

Practice location:
  • Phone: 408-465-8280
  • Fax: 408-465-8281
Mailing address:
  • Phone: 408-439-0846
  • Fax: 408-465-8281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: