Provider Demographics
NPI:1972512226
Name:CRUZ, CLARISSA TORRES (PTA)
Entity Type:Individual
Prefix:MISS
First Name:CLARISSA
Middle Name:TORRES
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14634 GAULT ST
Mailing Address - Street 2:#3
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3049
Mailing Address - Country:US
Mailing Address - Phone:818-908-1153
Mailing Address - Fax:
Practice Address - Street 1:9700 DE SOTO AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4409
Practice Address - Country:US
Practice Address - Phone:818-882-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3825225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant