Healthcare Provider Details

I. General information

NPI: 1548197635
Provider Name (Legal Business Name): EMILIO GRAU CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DRIVE SUITE 200
ORLANDO FL
32729
US

IV. Provider business mailing address

133 BENMORE DR STE 200
WINTER PARK FL
32792-4111
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7070
  • Fax:
Mailing address:
  • Phone: 407-646-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: