Healthcare Provider Details

I. General information

NPI: 1447170154
Provider Name (Legal Business Name): ERICK CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W KATELLA AVE STE 150
ORANGE CA
92867-3432
US

IV. Provider business mailing address

229 E COMMONWEALTH AVE APT 148
FULLERTON CA
92832-4905
US

V. Phone/Fax

Practice location:
  • Phone: 714-904-5438
  • Fax:
Mailing address:
  • Phone: 657-554-6327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: