Provider Demographics
NPI:1962248179
Name:CRUZ, AIMEE JEAN
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:JEAN
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 1:3032 SAGE PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1507
Mailing Address - Country:US
Mailing Address - Phone:630-802-8024
Mailing Address - Fax:
Practice Address - Street 1:3848 W CARSON ST STE 115
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6704
Practice Address - Country:US
Practice Address - Phone:424-206-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health