MEDICARE: ODALIS LESLIE CRUZ RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	766400	NY

General Provider Information

NPI Number	:	1043874670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODALIS LESLIE CRUZ RN

Provider Business Mailing Address
First Line	:	2571 EAST 17TH STREET GROUND FLOOR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1011
Country	:	US
Telephone Number	:	929-371-2131
Fax Number	:	929-259-5277

Provider Business Practice Location Address
First Line	:	2571 EAST 17TH STREET GROUND FLOOR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1123
Country	:	US
Telephone Number	:	929-371-2131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	05/03/2019

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