Healthcare Provider Details

I. General information

NPI: 1265978563
Provider Name (Legal Business Name): DR. ALEJANDRO CRUZ SOLIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 SE 5TH PL
HIALEAH FL
33010-5434
US

IV. Provider business mailing address

676 SE 5TH PL
HIALEAH FL
33010-5434
US

V. Phone/Fax

Practice location:
  • Phone: 305-904-8903
  • Fax:
Mailing address:
  • Phone: 305-904-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-19-10638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: