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NPI Code Detail

MEDICARE: GUILLERMO CRUZ

MEDICARE: GUILLERMO CRUZ
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1164866653
Entity Type Code : Individual
Provider Name (Legal Business Name) : GUILLERMO CRUZ
Provider Business Mailing Address
First Line : 11046 MAIN ST
Second Line :
City : EL MONTE
State : CA
Zip : 91731-2617
Country : US
Telephone Number : 626-636-2370
Fax Number :
Provider Business Practice Location Address
First Line : 360 S WESTLAKE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2906
Country : US
Telephone Number : 213-483-9205
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2013
Last Update Date : 08/29/2024

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Directions to “ GUILLERMO CRUZ ” Practice Location

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