Healthcare Provider Details

I. General information

NPI: 1225946619
Provider Name (Legal Business Name): ELIEN CRUZ PONTIGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5571 N UNIVERSITY DR STE 101
CORAL SPRINGS FL
33067-4653
US

IV. Provider business mailing address

5571 N UNIVERSITY DR STE 101
CORAL SPRINGS FL
33067-4653
US

V. Phone/Fax

Practice location:
  • Phone: 954-790-5338
  • Fax:
Mailing address:
  • Phone: 954-790-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2837741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: