Provider Demographics
NPI:1790654234
Name:CRUZ, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HARTNELL AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-5010
Mailing Address - Country:US
Mailing Address - Phone:510-725-5813
Mailing Address - Fax:
Practice Address - Street 1:2001 HARTNELL AVE APT 17
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-5010
Practice Address - Country:US
Practice Address - Phone:510-725-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-22-247705106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty