Healthcare Provider Details

I. General information

NPI: 1215089693
Provider Name (Legal Business Name): JACINTA MARIA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HAIGHT ST
SAN FRANCISCO CA
94102-6127
US

IV. Provider business mailing address

214 HAIGHT ST
SAN FRANCISCO CA
94102-6127
US

V. Phone/Fax

Practice location:
  • Phone: 415-554-1480
  • Fax: 415-241-5599
Mailing address:
  • Phone: 415-554-1480
  • Fax: 415-241-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: