Healthcare Provider Details

I. General information

NPI: 1285351684
Provider Name (Legal Business Name): MOLLY CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5563 FAR HILLS AVE
DAYTON OH
45429-2225
US

IV. Provider business mailing address

5563 FAR HILLS AVE
DAYTON OH
45429-2225
US

V. Phone/Fax

Practice location:
  • Phone: 937-291-2300
  • Fax: 937-291-2303
Mailing address:
  • Phone: 937-291-2300
  • Fax: 937-291-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: