Provider Demographics
NPI:1396227799
Name:CRUZ, AARON JUSTINIANI (COTA)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:JUSTINIANI
Last Name:CRUZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8867 N HAYSTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1960
Mailing Address - Country:US
Mailing Address - Phone:904-403-8468
Mailing Address - Fax:
Practice Address - Street 1:517 S A ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3806
Practice Address - Country:US
Practice Address - Phone:559-673-9228
Practice Address - Fax:559-674-7199
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA2993224ZF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & SwallowingGroup - Single Specialty