Healthcare Provider Details

I. General information

NPI: 1124501663
Provider Name (Legal Business Name): KATIE LORREN CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SANTA BARBARA ST
SANTA BARBARA CA
93101-2232
US

IV. Provider business mailing address

720 SANTA BARBARA ST
SANTA BARBARA CA
93101-2232
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-4338
  • Fax:
Mailing address:
  • Phone: 805-963-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118185
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW97840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: