Healthcare Provider Details

I. General information

NPI: 1902455835
Provider Name (Legal Business Name): RACHAEL CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11450 N MERIDIAN ST STE 100
CARMEL IN
46032-4688
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 317-689-7850
  • Fax: 317-520-8200
Mailing address:
  • Phone: 317-449-4833
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-36940
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: