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General NPI Number Information
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NPI Number | 1124399613
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Entity Type | Individual
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Provider Name | CLEOFE SECULAR CRUZ R.N.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 1663 E 17TH ST
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City | BROOKLYN
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State | NY
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Zip | 11229-1259
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Country | US
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Telephone | 718-998-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 9705 HORACE HARDING EXPY 14-O
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City | CORONA
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State | NY
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Zip | 11368-4157
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Country | US
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Telephone | 347-420-9452
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 635507
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 635507
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License Number State | NY
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