Healthcare Provider Details

I. General information

NPI: 1710171848
Provider Name (Legal Business Name): MISS VANESSA M. CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E FOOTHILL BLVD
PASADENA CA
91107-3464
US

IV. Provider business mailing address

1402 MILLBURY AVE
LA PUENTE CA
91746-1036
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-1613
  • Fax:
Mailing address:
  • Phone: 626-337-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number74974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: