Provider Demographics
NPI:1841810561
Name:CRUZ, LESLIE (DPT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 MANCHESTER AVE APT C
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1834
Mailing Address - Country:US
Mailing Address - Phone:732-406-4811
Mailing Address - Fax:
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3719
Practice Address - Country:US
Practice Address - Phone:619-299-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist