Provider Demographics
NPI:1194079913
Name:CRUZE, KIMBERLY
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:CRUZE
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 1:800 S.SANTA ANITA AVENUE
Mailing Address - Street 2:HUMAN RESOURCES/CHRISTINA GAMBOA
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-254-5000
Mailing Address - Fax:626-294-1079
Practice Address - Street 1:800 S SANTA ANITA AVE
Practice Address - Street 2:HUMAN RESOURCES/CHRISTINA GAMBOA
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3536
Practice Address - Country:US
Practice Address - Phone:909-622-2273
Practice Address - Fax:909-622-6334
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194079913Medicaid