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NPI Code Detail

MEDICARE: MISS ZETH ANNE R CRUZ M.A., SLPA

MEDICARE: MISS ZETH ANNE R CRUZ M.A., SLPA
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
12355S0801XSpeech-Language Assistant2498CA
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1164850418
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ZETH ANNE R CRUZ M.A., SLPA
Provider Business Mailing Address
First Line : 445 IVY ST APT 205
Second Line :
City : GLENDALE
State : CA
Zip : 91204-1235
Country : US
Telephone Number : 323-360-3134
Fax Number :
Provider Business Practice Location Address
First Line : 611 N BRAND BLVD STE 100
Second Line :
City : GLENDALE
State : CA
Zip : 91203-3240
Country : US
Telephone Number : 747-286-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2013
Last Update Date : 08/26/2021

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