Provider Demographics
NPI:1093216707
Name:CRUZ, DIANA VERONICA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:VERONICA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 E HUNTINGTON AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-4904
Mailing Address - Country:US
Mailing Address - Phone:559-679-5885
Mailing Address - Fax:
Practice Address - Street 1:4747 N. FIRST ST.
Practice Address - Street 2:105 & 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726
Practice Address - Country:US
Practice Address - Phone:916-729-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician