Provider Demographics
NPI:1972350239
Name:CRUZ, JAIME EMILIO (APCC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:EMILIO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13017 GLAMIS ST
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3237
Mailing Address - Country:US
Mailing Address - Phone:818-233-6865
Mailing Address - Fax:
Practice Address - Street 1:9029 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3932
Practice Address - Country:US
Practice Address - Phone:626-268-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health