Provider Demographics
NPI:1760959837
Name:CRUZ, MATTHEW JACOB
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JACOB
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 1:1024 WHOOPER WAY
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2936
Mailing Address - Country:US
Mailing Address - Phone:707-310-0393
Mailing Address - Fax:
Practice Address - Street 1:1024 WHOOPER WAY
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-2936
Practice Address - Country:US
Practice Address - Phone:707-310-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst