Healthcare Provider Details

I. General information

NPI: 1336701804
Provider Name (Legal Business Name): CELINE VERA CRUZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14766 WASHINGTON AVE
SAN LEANDRO CA
94578-4220
US

IV. Provider business mailing address

4920 BRIDGEPOINTE PL
UNION CITY CA
94587-5564
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-2211
  • Fax:
Mailing address:
  • Phone: 510-365-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: