Healthcare Provider Details

I. General information

NPI: 1073417630
Provider Name (Legal Business Name): SARA CRUZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 E WALNUT ST STE 208
PASADENA CA
91106-1453
US

IV. Provider business mailing address

1142 WEST BLVD
LOS ANGELES CA
90019-1852
US

V. Phone/Fax

Practice location:
  • Phone: 818-570-1636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: