Provider Demographics
NPI:1528693710
Name:CRUZ, EMILY FOWLER
Entity type:Individual
Prefix:PROF
First Name:EMILY
Middle Name:FOWLER
Last Name:CRUZ
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 1:1900 WESTMINSTER LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3938
Mailing Address - Country:US
Mailing Address - Phone:510-710-7971
Mailing Address - Fax:
Practice Address - Street 1:1900 WESTMINSTER LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3938
Practice Address - Country:US
Practice Address - Phone:510-710-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist