MEDICARE: MRS. DAMARYS 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	106S00000X	Behavior Technician

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	:	1922549617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAMARYS CRUZ

Provider Business Mailing Address
First Line	:	3029 SW 14TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-1103
Country	:	US
Telephone Number	:	786-683-6165
Fax Number	:

Provider Business Practice Location Address
First Line	:	2583 SW 21ST AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2454
Country	:	US
Telephone Number	:	786-683-6165
Fax Number	:

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

Provider Enumeration Date	:	03/14/2017
Last Update Date	:	12/28/2018

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Directions to “ MRS. DAMARYS CRUZ ” Practice Location

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