Provider Demographics
NPI:1417003955
Name:CRUZ, LESLIE L (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:L
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 AERO DR STE 221
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1767
Mailing Address - Country:US
Mailing Address - Phone:619-405-6719
Mailing Address - Fax:858-268-9810
Practice Address - Street 1:9815 CARROLL CANYON RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1123
Practice Address - Country:US
Practice Address - Phone:619-405-6719
Practice Address - Fax:858-566-7446
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist