Provider Demographics
NPI:1578933446
Name:SANTA CRUZ, MARTHA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ANN
Last Name:SANTA CRUZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:ANN
Other - Last Name:SANTA CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:46618 MADISON ST SPC 104
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5349
Mailing Address - Country:US
Mailing Address - Phone:760-534-3134
Mailing Address - Fax:
Practice Address - Street 1:46618 MADISON ST SPC 104
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5349
Practice Address - Country:US
Practice Address - Phone:760-534-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-04
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional