Healthcare Provider Details

I. General information

NPI: 1336820604
Provider Name (Legal Business Name): CHRISTINE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 VON KARMAN AVE STE 120
NEWPORT BEACH CA
92660-2172
US

IV. Provider business mailing address

1725 S AUBURN WAY UNIT 632
ANAHEIM CA
92805-6635
US

V. Phone/Fax

Practice location:
  • Phone: 949-407-9859
  • Fax:
Mailing address:
  • Phone: 331-472-9473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: