Provider Demographics
NPI:1760715676
Name:CRUZ, BILLY
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5112
Mailing Address - Country:US
Mailing Address - Phone:213-381-5292
Mailing Address - Fax:213-381-5293
Practice Address - Street 1:1300 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3908
Practice Address - Country:US
Practice Address - Phone:213-381-5292
Practice Address - Fax:213-381-5293
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)