Provider Demographics
NPI:1760049035
Name:CRUZ KNOWLTON, CASSANDRA ROSE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ROSE
Last Name:CRUZ KNOWLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:ROSE
Other - Last Name:CRUZ KNOWLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASSANDRA ROSE CRUZ
Mailing Address - Street 1:867 STACEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-1714
Mailing Address - Country:US
Mailing Address - Phone:760-562-9479
Mailing Address - Fax:
Practice Address - Street 1:11650 IBERIA PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2406
Practice Address - Country:US
Practice Address - Phone:858-877-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician