Healthcare Provider Details

I. General information

NPI: 1376938183
Provider Name (Legal Business Name): JASMINE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 W BOYNTON BEACH BLVD STE 7
BOYNTON BEACH FL
33437-6155
US

IV. Provider business mailing address

230 VIA D ESTE APT 1506
DELRAY BEACH FL
33445-3978
US

V. Phone/Fax

Practice location:
  • Phone: 561-369-2199
  • Fax: 561-935-1582
Mailing address:
  • Phone: 407-535-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO3913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: