Provider Demographics
NPI:1942680541
Name:CRUZ, DIYA
Entity Type:Individual
Prefix:
First Name:DIYA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5142 BANCROFT AVE
Mailing Address - Street 2:APT 304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-5364
Mailing Address - Country:US
Mailing Address - Phone:415-509-2200
Mailing Address - Fax:
Practice Address - Street 1:5142 BANCROFT AVE
Practice Address - Street 2:APT 304
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-5364
Practice Address - Country:US
Practice Address - Phone:415-509-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist