Provider Demographics
NPI:1588782866
Name:CRUZ, VICTORIA JANE (MFT)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:JANE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EAST ST STE 123
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-4980
Mailing Address - Country:US
Mailing Address - Phone:530-668-6765
Mailing Address - Fax:
Practice Address - Street 1:825 EAST ST STE 123
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4980
Practice Address - Country:US
Practice Address - Phone:530-668-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41770106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist