Healthcare Provider Details

I. General information

NPI: 1568060242
Provider Name (Legal Business Name): AZUL COMMUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 SW 124TH RD
MIAMI FL
33186-3649
US

IV. Provider business mailing address

10535 SW 124TH RD
MIAMI FL
33186-3649
US

V. Phone/Fax

Practice location:
  • Phone: 305-418-0608
  • Fax: 305-418-0609
Mailing address:
  • Phone: 305-418-0608
  • Fax: 305-418-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: CECILIA A DE LA CRUZ
Title or Position: PRESIDENT
Credential: LCSW, BCBA
Phone: 305-418-0608