Healthcare Provider Details

I. General information

NPI: 1588588537
Provider Name (Legal Business Name): KORINA ANGELA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WOOL CREEK DR
SAN JOSE CA
95112-2617
US

IV. Provider business mailing address

663 N WHITE RD
SAN JOSE CA
95127-1447
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number32905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: