Healthcare Provider Details

I. General information

NPI: 1568934214
Provider Name (Legal Business Name): MR. TRISTAN JAY CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 MITCHELL AVE
OROVILLE CA
95965-4646
US

IV. Provider business mailing address

2740 ORO DAM BLVD E
OROVILLE CA
95966-5117
US

V. Phone/Fax

Practice location:
  • Phone: 530-538-7950
  • Fax:
Mailing address:
  • Phone: 530-712-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: