MEDICARE: VERONICA ALEXIS CRUZ MSOT/R

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	225XP0200X	Pediatric Occupational Therapist	OT-15211	FL

General Provider Information

NPI Number	:	1053751982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA ALEXIS CRUZ MSOT/R

Provider Business Mailing Address
First Line	:	6931 TAYLOR ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-7455
Country	:	US
Telephone Number	:	305-331-2105
Fax Number	:

Provider Business Practice Location Address
First Line	:	6931 TAYLOR ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-0000
Country	:	US
Telephone Number	:	305-331-2105
Fax Number	:

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

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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