Healthcare Provider Details

I. General information

NPI: 1821932310
Provider Name (Legal Business Name): ELIANIS CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 ANTILLA AVE
CORAL GABLES FL
33134-3301
US

IV. Provider business mailing address

3299 SW 173RD TER
MIRAMAR FL
33029-5583
US

V. Phone/Fax

Practice location:
  • Phone: 754-267-4372
  • Fax:
Mailing address:
  • Phone: 754-267-4372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-439119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: