Healthcare Provider Details

I. General information

NPI: 1922626845
Provider Name (Legal Business Name): JOSE CRUZ ALEJO MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 S K ST
TULARE CA
93274-5416
US

IV. Provider business mailing address

327 S K ST
TULARE CA
93274-5416
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-2043
  • Fax: 559-688-1304
Mailing address:
  • Phone: 559-688-2043
  • Fax: 559-688-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: