Healthcare Provider Details

I. General information

NPI: 1912673476
Provider Name (Legal Business Name): BERONICA OFELIA CRUZ HAMILL IFC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3859 S ELAINE DR
WARSAW IN
46580-6272
US

IV. Provider business mailing address

PO BOX 413
WINONA LAKE IN
46590-0413
US

V. Phone/Fax

Practice location:
  • Phone: 574-551-7999
  • Fax:
Mailing address:
  • Phone: 260-527-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: