Healthcare Provider Details

I. General information

NPI: 1043908734
Provider Name (Legal Business Name): MRS. RUTH CUZAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 04/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10671 N KENDALL DR
MIAMI FL
33176-1510
US

IV. Provider business mailing address

10671 N KENDALL DR
MIAMI FL
33176-1510
US

V. Phone/Fax

Practice location:
  • Phone: 786-416-0811
  • Fax: 786-558-5483
Mailing address:
  • Phone: 786-416-0811
  • Fax: 786-558-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number499545
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH21607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: