Healthcare Provider Details

I. General information

NPI: 1932858909
Provider Name (Legal Business Name): GERARDO STEVEN CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19231 VICTORY BLVD STE 110
RESEDA CA
91335-6321
US

IV. Provider business mailing address

19231 VICTORY BLVD STE 110
RESEDA CA
91335-6321
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-4500
  • Fax:
Mailing address:
  • Phone: 818-708-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT138792
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: