MEDICARE: MR. OMAR CRUZ

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	225700000X	Massage Therapist	MA62200	FL

General Provider Information

NPI Number	:	1083913297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OMAR CRUZ

Provider Business Mailing Address
First Line	:	P.O. BOX 35-0531
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135
Country	:	US
Telephone Number	:	786-380-0929
Fax Number	:

Provider Business Practice Location Address
First Line	:	1838 NW FLAGLER TERRACE
Second Line	:	APT 7
City	:	MIAMI
State	:	FL
Zip	:	33125
Country	:	US
Telephone Number	:	786-380-0929
Fax Number	:

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

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/28/2011

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