MEDICARE: DEVORA 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	261QD1600X	Developmental Disabilities Clinic/Center		FL

General Provider Information

NPI Number	:	1154915023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVORA CRUZ

Provider Business Mailing Address
First Line	:	PO BOX 5483
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33466-5483
Country	:	US
Telephone Number	:	561-779-8027
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S SAPODILLA AVE STE 204
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5208
Country	:	US
Telephone Number	:	561-779-8027
Fax Number	:

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

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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Directions to “ DEVORA CRUZ ” Practice Location

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