Healthcare Provider Details

I. General information

NPI: 1801244009
Provider Name (Legal Business Name): ANA CRUELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 W 44TH PL APT 203
HIALEAH FL
33012-8408
US

IV. Provider business mailing address

4390 W 12TH LN APT 4
HIALEAH FL
33012-5998
US

V. Phone/Fax

Practice location:
  • Phone: 786-863-1361
  • Fax:
Mailing address:
  • Phone: 786-863-1361
  • 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 Code247200000X
TaxonomyOther Technician
License NumberRBT-15-05879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: