MEDICARE: ANA GRACIELA CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	19276	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124435763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA GRACIELA CRUZ

Provider Business Mailing Address
First Line	:	8333 WEST OKEECHOBE ROAD
Second Line	:	.
City	:	HIALEAH
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8333 W OKEECHOBEE RD
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-2109
Country	:	US
Telephone Number	:	786-683-4391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	05/06/2021

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