Healthcare Provider Details

I. General information

NPI: 1730084781
Provider Name (Legal Business Name): YAZMIN SUGUEY CABRERA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 JANESSA WAY
STOCKTON CA
95205-8405
US

IV. Provider business mailing address

PO BOX 32093
STOCKTON CA
95213-2093
US

V. Phone/Fax

Practice location:
  • Phone: 209-565-7764
  • Fax:
Mailing address:
  • Phone: 209-565-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number99274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: