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General NPI Number Information
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NPI Number | 1710171848
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Entity Type | Individual
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Provider Name | MISS VANESSA M. CRUZ
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Gender | Female
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 2500 E FOOTHILL BLVD
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City | PASADENA
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State | CA
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Zip | 91107-3464
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Country | US
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Telephone | 626-564-1613
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 MILLBURY AVE
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City | LA PUENTE
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State | CA
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Zip | 91746-1036
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Country | US
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Telephone | 626-337-6175
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 74974
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License Number State | CA
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