Healthcare Provider Details

I. General information

NPI: 1124452339
Provider Name (Legal Business Name): JOEL LAZARO DE LA TORRE CRUZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9804 SW 40TH ST
MIAMI FL
33165-3912
US

IV. Provider business mailing address

14311 SW 88TH ST APT A208
MIAMI FL
33186-8078
US

V. Phone/Fax

Practice location:
  • Phone: 305-222-9154
  • Fax: 305-222-9155
Mailing address:
  • Phone: 305-926-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11018107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: