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General NPI Number Information
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NPI Number | 1063120053
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Entity Type | Individual
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Provider Name | SOJHAM ANDREINA RAY CRUZ RBT
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Gender | Female
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 5600 SPRING PARK RD STE 200
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5989
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Country | US
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Telephone | 786-525-3114
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Fax | 855-226-6396
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Provider Business Mailing Address
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Address Line | 6014 WATEREDGE LN
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City | JACKSONVILLE
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State | FL
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Zip | 32211-7540
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Country | US
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Telephone | 904-666-5147
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Fax | 855-226-6396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-21-187109
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License Number State | FL
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