Provider Demographics
NPI:1134254337
Name:DE LA CRUZ, BRENDA ANASTACIA (CATS)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ANASTACIA
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:CATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 N VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-3419
Mailing Address - Country:US
Mailing Address - Phone:559-266-9581
Mailing Address - Fax:559-498-0507
Practice Address - Street 1:539 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3419
Practice Address - Country:US
Practice Address - Phone:559-266-9581
Practice Address - Fax:559-498-0507
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA051115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)