Provider Demographics
NPI:1477632933
Name:CRUZ, JUANITA L
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:L
Last Name:CRUZ
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 1:369 W COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3110
Mailing Address - Country:US
Mailing Address - Phone:310-669-9510
Mailing Address - Fax:310-669-9501
Practice Address - Street 1:369 W COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3110
Practice Address - Country:US
Practice Address - Phone:310-669-9510
Practice Address - Fax:310-669-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health