Provider Demographics
NPI:1275277931
Name:RODRIGUEZ, CRUZ
Entity Type:Individual
Prefix:
First Name:CRUZ
Middle Name:
Last Name:RODRIGUEZ
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 1:1930 HOWARD RD STE 119
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5155
Mailing Address - Country:US
Mailing Address - Phone:559-267-8323
Mailing Address - Fax:559-354-8232
Practice Address - Street 1:1930 HOWARD RD STE 119
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5155
Practice Address - Country:US
Practice Address - Phone:559-267-8323
Practice Address - Fax:559-354-8232
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician