Provider Demographics
NPI:1609527811
Name:CRUZ, JENNIFER K (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:CRUZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIOR ANALYST
Mailing Address - Street 1:3258 OVERLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3503
Mailing Address - Country:US
Mailing Address - Phone:323-898-6831
Mailing Address - Fax:
Practice Address - Street 1:3258 OVERLAND AVE APT 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3503
Practice Address - Country:US
Practice Address - Phone:323-898-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-53977103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst