Provider Demographics
NPI:1467340885
Name:CRUZ-WILCHES, JACQUELINE (CMT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CRUZ-WILCHES
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 SANTA ROSA AVE # 9
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-8269
Mailing Address - Country:US
Mailing Address - Phone:310-997-6849
Mailing Address - Fax:
Practice Address - Street 1:7530 COMMERCE BLVD STE F
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-3700
Practice Address - Country:US
Practice Address - Phone:310-997-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist