Provider Demographics
NPI:1962238485
Name:CRUZ, CHRYSTAL MYE
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:MYE
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 1:658 E BRIER DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2880
Mailing Address - Country:US
Mailing Address - Phone:909-252-5112
Mailing Address - Fax:909-501-0832
Practice Address - Street 1:658 E BRIER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2880
Practice Address - Country:US
Practice Address - Phone:909-252-5112
Practice Address - Fax:909-501-0832
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC16015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health