Healthcare Provider Details

I. General information

NPI: 1215535778
Provider Name (Legal Business Name): STEPHANIE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 RANCHO CAMINO DR FL 2
POMONA CA
91766-7030
US

IV. Provider business mailing address

31 RANCH CAMINO DR. FLOOR 2
POMONA CA
91766
US

V. Phone/Fax

Practice location:
  • Phone: 909-618-0974
  • Fax:
Mailing address:
  • Phone: 951-893-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: