Basic Information
| Provider Information | |||||||||
| NPI: | 1568864874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DA CRUZ | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | KUNKEL-DA CRUZ | ||||||||
| OtherFirstName: | HANNAH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3301 E 12TH ST | ||||||||
| Address2: | SUITE 259 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3301 E 12TH ST | ||||||||
| Address2: | SUITE 259 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102699030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2014 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | CA | N | Behavioral Health & Social Service Providers | Psychologist | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.