Healthcare Provider Details

I. General information

NPI: 1013649482
Provider Name (Legal Business Name): ANNA KATRINA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W CHAPMAN AVE
ORANGE CA
92868-2847
US

IV. Provider business mailing address

1010 W CHAPMAN AVE
ORANGE CA
92868-2847
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-4300
  • Fax:
Mailing address:
  • Phone: 714-633-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: