Provider Demographics
NPI:1174295794
Name:CRUZ, DARIAN LEE
Entity Type:Individual
Prefix:
First Name:DARIAN
Middle Name:LEE
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18333 DOLAN WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-5422
Mailing Address - Country:US
Mailing Address - Phone:661-214-7174
Mailing Address - Fax:
Practice Address - Street 1:18333 DOLAN WAY STE 103
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-5422
Practice Address - Country:US
Practice Address - Phone:661-214-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty