Provider Demographics
NPI:1669187969
Name:BAEZ-CRUZ, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:BAEZ-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 1:915 BLANCO CIR STE C
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4450
Mailing Address - Country:US
Mailing Address - Phone:831-754-1603
Mailing Address - Fax:
Practice Address - Street 1:915 BLANCO CIR STE C
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4450
Practice Address - Country:US
Practice Address - Phone:831-754-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-57123103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst