Healthcare Provider Details

I. General information

NPI: 1356148985
Provider Name (Legal Business Name): NICOLE CIFUENTES CRUZ SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 NW 24TH WAY
BOCA RATON FL
33431-6271
US

IV. Provider business mailing address

2907 NW 24TH WAY
BOCA RATON FL
33431-6271
US

V. Phone/Fax

Practice location:
  • Phone: 561-836-2224
  • Fax:
Mailing address:
  • Phone: 561-836-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number25-179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: