Healthcare Provider Details

I. General information

NPI: 1649941832
Provider Name (Legal Business Name): GEOVANI CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N A ST
OXNARD CA
93030-4916
US

IV. Provider business mailing address

410 N A ST
OXNARD CA
93030-4916
US

V. Phone/Fax

Practice location:
  • Phone: 805-487-2244
  • Fax: 805-487-2255
Mailing address:
  • Phone: 805-487-2244
  • Fax: 805-487-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: