Healthcare Provider Details

I. General information

NPI: 1508414475
Provider Name (Legal Business Name): LIZBETH CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 COE AVE
SEASIDE CA
93955-6589
US

IV. Provider business mailing address

700 PACIFIC ST
MONTEREY CA
93940-2815
US

V. Phone/Fax

Practice location:
  • Phone: 831-645-1261
  • Fax:
Mailing address:
  • Phone: 831-645-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220207219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: