Provider Demographics
NPI:1285702175
Name:CRUZ, PATRICIA MARGARETE (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARGARETE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30011 IVY GLENN DR
Mailing Address - Street 2:SUITE NUMBER 216
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5014
Mailing Address - Country:US
Mailing Address - Phone:949-280-5651
Mailing Address - Fax:
Practice Address - Street 1:30011 IVY GLENN DR
Practice Address - Street 2:SUITE NUMBER 216
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5014
Practice Address - Country:US
Practice Address - Phone:949-280-5651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41619106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist