Provider Demographics
NPI:1639862832
Name:CRUZ, EILEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44897 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5863
Mailing Address - Country:US
Mailing Address - Phone:917-821-6223
Mailing Address - Fax:
Practice Address - Street 1:325 POTTER ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3068
Practice Address - Country:US
Practice Address - Phone:909-557-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25054225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist