Basic Information
| Provider Information | |||||||||
| NPI: | 1164850418 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | ZETH ANNE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.A., SLPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 IVY ST APT 205 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912041235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233603134 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 611 N BRAND BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912033240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7472862600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | 2498 | CA | N | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 106S00000X | Y |
No ID Information.