Provider Demographics
NPI:1649493800
Name:CRUZ, HENRY (PT)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PASEO CAMARILLO
Mailing Address - Street 2:APT 316
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5983
Mailing Address - Country:US
Mailing Address - Phone:805-383-4050
Mailing Address - Fax:
Practice Address - Street 1:145 HODENCAMP RD
Practice Address - Street 2:SUITE #100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5810
Practice Address - Country:US
Practice Address - Phone:805-449-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist