Provider Demographics
NPI:1275881120
Name:CRUZ-RINE, ROSALINE (MA, MFT)
Entity Type:Individual
Prefix:
First Name:ROSALINE
Middle Name:
Last Name:CRUZ-RINE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:ROSALINE
Other - Middle Name:M
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1341 W ROBINHOOD DR
Mailing Address - Street 2:SUITE B-10
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5515
Mailing Address - Country:US
Mailing Address - Phone:209-957-9001
Mailing Address - Fax:209-957-9004
Practice Address - Street 1:1341 W ROBINHOOD DR
Practice Address - Street 2:SUITE B-10
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5515
Practice Address - Country:US
Practice Address - Phone:209-957-9001
Practice Address - Fax:209-957-9004
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49096106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist