Provider Demographics
NPI:1912025107
Name:CRUZ, GRACIELA
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACIELA
Other - Middle Name:
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:675 TEXAS ST STE 3800
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6372
Mailing Address - Country:US
Mailing Address - Phone:707-784-8101
Mailing Address - Fax:707-427-2784
Practice Address - Street 1:675 TEXAS ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6372
Practice Address - Country:US
Practice Address - Phone:707-784-8101
Practice Address - Fax:707-427-2784
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator