Provider Demographics
NPI:1386761856
Name:SANTA CRUZ, JUAN CARLOS (MS)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLOS
Last Name:SANTA CRUZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27263 ASHFIELD PL
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-2108
Mailing Address - Country:US
Mailing Address - Phone:661-367-4563
Mailing Address - Fax:
Practice Address - Street 1:22777 LYONS AVE.
Practice Address - Street 2:STE 218
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2847
Practice Address - Country:US
Practice Address - Phone:818-730-1914
Practice Address - Fax:661-554-3501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81237106H00000X
CA81327106H00000X
CA42316106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist