MEDICARE: CINDY DAIRYN 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	RI-C1212281627	CA

General Provider Information

NPI Number	:	1174860647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY DAIRYN CRUZ

Provider Business Mailing Address
First Line	:	1347 W 90TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-2031
Country	:	US
Telephone Number	:	323-239-3703
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 W IMPERIAL HWY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5021
Country	:	US
Telephone Number	:	323-750-2850
Fax Number	:	323-750-0851

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

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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