Healthcare Provider Details

I. General information

NPI: 1629116090
Provider Name (Legal Business Name): MR. LUIS ALBERTO CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4996 LA SIERRA AVE
RIVERSIDE CA
92505-2612
US

IV. Provider business mailing address

4996 LA SIERRA AVE
RIVERSIDE CA
92505-2612
US

V. Phone/Fax

Practice location:
  • Phone: 951-500-2774
  • Fax: 951-358-0762
Mailing address:
  • Phone: 951-525-3752
  • Fax: 951-358-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: