Healthcare Provider Details

I. General information

NPI: 1619682630
Provider Name (Legal Business Name): MARCO A CRUZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 W MINERAL KING AVE
VISALIA CA
93291-5711
US

IV. Provider business mailing address

603 CRESTWOOD CT
WOODLAKE CA
93286-2108
US

V. Phone/Fax

Practice location:
  • Phone: 559-667-2427
  • Fax:
Mailing address:
  • Phone: 559-769-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT159047
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: