Provider Demographics
NPI:1457901399
Name:CRUZ, ANGELICA MARIE (SLPA)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:MARIE
Other - Last Name:HISEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:200 VILLAGE DR APT 3E
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8660 BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5655
Practice Address - Country:US
Practice Address - Phone:925-626-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty