=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992669063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRUZ BEHAVIORAL GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2025
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1687 BUCKEYE FALLS WAY
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32824-4347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-837-3039
-----------------------------------------------------
Fax | 689-223-7310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1687 BUCKEYE FALLS WAY
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32824-4347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-837-3039
-----------------------------------------------------
Fax | 689-223-7310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOSE M. CRUZ CARLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-445-8915
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------