Healthcare Provider Details

I. General information

NPI: 1346979853
Provider Name (Legal Business Name): YALET CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 GOODLETTE-FRANK RD N STE 1
NAPLES FL
34102-5644
US

IV. Provider business mailing address

191 20TH AVE NE
NAPLES FL
34120-2318
US

V. Phone/Fax

Practice location:
  • Phone: 239-351-0675
  • Fax:
Mailing address:
  • Phone: 239-328-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-224198
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: