Healthcare Provider Details

I. General information

NPI: 1740026210
Provider Name (Legal Business Name): YADIRA GRACIELA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 FOUR OAKS CIR
SAN JOSE CA
95131-2647
US

IV. Provider business mailing address

5909 SOUTHRIDGE CT
SAN JOSE CA
95138-1832
US

V. Phone/Fax

Practice location:
  • Phone: 408-807-7111
  • Fax:
Mailing address:
  • Phone: 408-807-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: