MEDICARE: MRS. ROSA CRUZ ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1154662328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSA CRUZ ACSW

Provider Business Mailing Address
First Line	:	149 S MEDNIK AVE # 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1606
Country	:	US
Telephone Number	:	323-981-9714
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 S MEDNIK AVE # 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1606
Country	:	US
Telephone Number	:	323-981-9714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2013
Last Update Date	:	12/04/2024

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