Provider Demographics
NPI:1700665007
Name:CRUZ, BREANNA MARIE (MS, CFY-RPE)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MS, CFY-RPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25102 JEFFERSON AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1708
Mailing Address - Country:US
Mailing Address - Phone:951-461-1190
Mailing Address - Fax:951-461-7975
Practice Address - Street 1:11870 PIERCE ST STE 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-6600
Practice Address - Country:US
Practice Address - Phone:951-808-5850
Practice Address - Fax:951-808-5860
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist