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General NPI Number Information
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NPI Number | 1740465020
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Entity Type | Individual
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Provider Name | LILIAN DE LA C CRUZ
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Gender | Female
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 11865 SW 26TH ST
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City | MIAMI
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State | FL
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Zip | 33175-2400
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Country | US
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Telephone | 305-552-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 15138 SW 129TH PL
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City | MIAMI
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State | FL
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Zip | 33186-6363
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Country | US
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Telephone | 305-278-2514
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO4908
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License Number State | FL
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