Provider Demographics
NPI:1689721516
Name:CRUZ, GILMA
Entity type:Individual
Prefix:MS
First Name:GILMA
Middle Name:
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 1:759 S VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1908
Mailing Address - Country:US
Mailing Address - Phone:415-642-4567
Mailing Address - Fax:415-695-6963
Practice Address - Street 1:759 S VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1908
Practice Address - Country:US
Practice Address - Phone:415-642-4567
Practice Address - Fax:415-695-6963
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 34982104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689721516Medicaid