Healthcare Provider Details

I. General information

NPI: 1689526501
Provider Name (Legal Business Name): LUCIANO CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SANTA MARTIA ST SW
PALM BAY FL
32908-3407
US

IV. Provider business mailing address

450 SANTA MARTIA ST SW
PALM BAY FL
32908-3407
US

V. Phone/Fax

Practice location:
  • Phone: 321-339-8124
  • Fax:
Mailing address:
  • Phone: 321-339-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: