Provider Demographics
NPI:1528863917
Name:CRUZ, SHARELLE REGINA (CMPSS, HHP, LMT)
Entity type:Individual
Prefix:MRS
First Name:SHARELLE
Middle Name:REGINA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CMPSS, HHP, LMT
Other - Prefix:
Other - First Name:SHARELLE
Other - Middle Name:REGINA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMPSS, HHP, LMT
Mailing Address - Street 1:550 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10717 CAMINO RUIZ STE 134
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2362
Practice Address - Country:US
Practice Address - Phone:858-465-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92163225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist