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General NPI Number Information
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NPI Number | 1912673476
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Entity Type | Individual
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Provider Name | BERONICA OFELIA CRUZ HAMILL IFC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 3859 S ELAINE DR
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City | WARSAW
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State | IN
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Zip | 46580-6272
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Country | US
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Telephone | 574-551-7999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 413
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City | WINONA LAKE
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State | IN
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Zip | 46590-0413
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Country | US
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Telephone | 260-527-2444
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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