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General NPI Number Information
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NPI Number | 1366769143
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Entity Type | Individual
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Provider Name | SUSAN SANTA CRUZ PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2010
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 2230 E SPEEDWAY BLVD SUITE 120
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City | TUCSON
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State | AZ
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Zip | 85719-4761
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Country | US
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Telephone | 520-661-2216
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Fax | 520-844-3100
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Provider Business Mailing Address
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Address Line | PO BOX 32821
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City | TUCSON
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State | AZ
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Zip | 85751-2821
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Country | US
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Telephone | 520-661-2216
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Fax | 520-844-3100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3619
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License Number State | AZ
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