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General NPI Number Information
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NPI Number | 1053010124
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Entity Type | Organization
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Legal Business Name | JACLYN CRUZ SPEECH LANGUAGE THERAPY, INC. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 13658 HAWTHORNE BLVD STE 205
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City | HAWTHORNE
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State | CA
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Zip | 90250-5822
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Country | US
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Telephone | 310-363-0251
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Fax |
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Provider Business Mailing Address
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Address Line | 13658 HAWTHORNE BLVD STE 205
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City | HAWTHORNE
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State | CA
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Zip | 90250-5822
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Country | US
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Telephone | 310-363-0251
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACLYN CRUZ
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Credential |
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Telephone | 310-363-0251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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